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- 1. ! ! ! ! ! ! ! ! Rogers’ Role inthe new M2M- Healthcare Ecosystem: Introducing Rogers Enterprise Medicom System (REMS) ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Seventh Heaven Consulting
- 2. Executive Summary 1 Introduction2 The Business Environment: A Lay of the Land 2 Disruptive Technology and REMS 2 Wearable Technology 4 Cloud Service and Big-Data Analytics 4 Healthcare 4 Internal Analysis 5 Rogers 5 Core Competencies and Partnership Synergies 5 REMS: Details 7 Developing Philosophy 7 Conceptual Framework: How is it going to work? 7 Potential application-features that can be achieved by REMS 8 Possible future uses 9 Security and Privacy 9 Revenue Model & Financial Projection 9 Buy-in for Stakeholders 10 Implementation 10 Reference 12 Appendix 15 Appendix A: Financial Projection 15 Appendix B: Grantt Chart 16 Table of Content
- 3. Executive Summary The market forsmartphones and tablets is currently reaching a state of maturity, and telecoms like Rogers must prepare for the future of communication.‘The Internet of Things’(IofT) and new disruptive machine to machine (M2M) innovations, will soon penetrate all areas of our lives, with potentially one trillion 'things' across several industries connected to the Internet and 100 million global M2M device connections (Manyika et al., 2013). In order to gain the best position in the promising M2M marketplace, what should Rogers invest in and how should it focus its competencies and grow its product offerings to remain relevant and profit generating in the changing landscape of telecom operations? ! Because of the growing need for value and efficiency in the healthcare industry, with nearly one-fifth of all M2M devices having healthcare applications by 2015 (Kane 2013), we have focused on growth for Rogers in the M2M-Healthcare ecosystem. The creation of Rogers Enterprise Medicom System (REMS) through strategic partnerships between Rogers (network infrastructure), IBM (cloud-service, analytics), and Google Glass (wearable technology), will ensure that Rogers plays a major role in the future of telecom in Canada. ! REMS' success depends on focused consideration of its business environment which consists of four key factors: (a)disruptive technology, (b)wearable technology, (c)cloud computing and big- ! ! ! ! ! data analytics, and (d)healthcare trends. By using its own competencies in fibre optics infrastructure, security, government lobbying power and expertise in developing healthcare apps it will be able to create great potential synergies with its strategic REMS partners. ! The REMS process follows a four step cycle: (a) a camera and a microphone situated on Google Glass provides graphic, auditory and location inputs to proxy servers located within the hospitals via a closed-network (b) servers encrypt and compress inputs that are transmitted to private cloud-servers for data storage and analysis; (c) processed data is forwarded to (IBM’s) Content Delivery Network and finally (d) data is transmitted back to the Google Glass’on-screen display as needed by the healthcare practitioner. The implications of REMS in the M2M- Healthcare ecosystem within five years are vast, but when REMS can be perfected through use and pilot project analyses, and as the M2M universe grows, the future application of REMS is truly unlimited. ! Initial financial projections indicate that upon the deployment of REMS, Rogers will generate $46M gross profit and a 49% gross profit margin derived from three standard revenue models: (1) enterprise hardware sales of Google Glass on contracts, (2) on- demand fee schedules for network and proxy server usage, and (3) maintenance and implementation fees. The future of M2M communication is limitless, and Rogers has the know-how, creativity and forward-thinking abilities to make REMS a reality. 1
- 4. Introduction ! As the marketfor smartphones and tablets matures, telecoms must embrace and prepare for the new reality of how the world is going to be communicating in the coming years. The‘Internet of Things’(IofT) is a very real concern with major implications for the telecom industry. Companies such as Rogers, Bell and Telus have traditionally been concerned with human to human (H2H) communications, but now because of new disruptive machine to machine (M2M) innovations, and the predicted $1B market revenue potential within the“M2M ecosystem”over the next three years in Canada (Trichur, 2013), Telecoms are recognizing the need to invest heavily in M2M services and solutions. Focus must be shifted from the human factor to the machine factor in order to remain relevant and revenue generating in the M2M ecosystem, where connectivity is becoming a commodity (Kane, 2013 & Chen, 2013). Seven Heaven Consulting has been tasked with the challenge of determining which industry will be impacted most dramatically by the IofT and M2M communication, and what the implications are for Telecoms over the next five years within a Canadian context. The following report elucidates the fact that the IofT and M2M communications are going to have drastic implications for the healthcare industry with nearly one-fifth of all M2M devices having healthcare applications by 2015 (Kane 2013). Investment by telecoms in the M2M- Healthcare industry is where they will reap the most rewards by creating urgently needed value for all stakeholders in the healthcare industry. With the creation of Rogers Enterprise Medicom System (REMS) through key partnerships between Rogers (network infrastructure), IBM (cloud-service, analytics), and Google Glass (wearable technology), Rogers will be positioned as a market leader in the M2M-Healthcare ecosystem; leading the charge to capitalize on the great potential that M2M-Healthcare can provide. ! The Business Environment : A Lay of the Land ! In order to understand the context within which REMS will operate, it is important to consider four factors that concern its business environment: a) disruptive technology, b) wearable technology c) cloud computing and big data analytics, and d) healthcare trends. ! Disruptive Technology and REMS Much of the information and communication technology (ICT) industry, including telecoms, is becoming increasingly influenced by disruptive innovations such as cloud computing and M2M communication. As "telecom companies are in the process of reinventing themselves...there's been a gradual shift from telephony as a major source of revenue" (Trichur, 2013), and disruptive technologies present an attractive prospect for investment in continued growth. M2M 2
- 5. technology, in combinationwith the IofT could make it possible to implant intelligence into anything at all. This fact alone elicits major implications for health, safety and overall global productivity (Manyika et al., 2013) . It is essential that telecoms such as Rogers are able to identify the potential uses for these disruptions within their current set of competencies, adjust their business models, and invest wisely to ensure they are not left behind in an ever-changing ICT industry. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Disruptive Innovation Theory identifies two types of innovation: sustaining innovation, and disruptive innovation (Christensen & Bower, 1995). As can be seen in Figure 1, sustaining innovations (blue line - i.e. Cloud- services, content delivery networks (CDN), and data-analytics (Babin & Magee, 2013)) maintain a steady performance and improve on an existing product or service. Innovations can only be considered as disruptive“when the value of a technology surpasses the value of a competing market”(Stutman, 2013). This event is recognised by red circle in Figure 1 where REMS’performance-improvement trajectory will exceed the goals of e-health in a 5-year period (Infoway, 2014; Anderson 2007). REMS combines existing sustaining innovations (blue line) with (possibly ! ! ! vv ! ! ! ! ! ! ! ! ! ! ! ! !! ! disruptive) Google Glass, to achieve a result that can revolutionize the way hospitals are able to communicate and store data. ! ! 3 Figure 1: REMS as a disruptive innovation Source: Adopted from Bower, J.L. & Christensen, C.M. (1995). Disruptive technologies: catching the wave.
- 6. Wearable Technology Wearable technologyis a constantly growing industry that is being catapulted by the Google-Samsung patent truce (Essers, 2014). Already on the market, and coming in 2014, are Nike’s extremely successful FuelBand activity tracker, and Sony’s smart watches and clever wristbands (Griffin, 2014). Nike’s profits jumped 18% largely due to the Fuel Band’s success, proving that there are profits to be made in this market (Warthon, 2014). In addition to the aforementioned examples, Jay Bird’s heart rate monitor, Georgia Tech’s Wearable Motherboard, and Google’s Google Glass (which has already been used in conjunction with healthcare by the surgical team at the University of Alabama (Farmanfarmaian, 2014)) all represent growth in the wearable technology industry, and now is the time for REMS to be carving out its own enterprise niche in the M2M-Healthcare ecosystem in order to take advantage of the great growth potential in wearable technology in the healthcare industry. ! Cloud Service and Big-Data Analytics According to a report on disruptive technologies by McKinsey,“cloud technology has the potential to improve productivity across $3 trillion in global enterprise IT spending, as well as enable the creation of new online products and services for billions of consumers and millions of businesses alike.”(Manyika et al., 2013). Forbes has also predicted that worldwide public IT cloud services spending will increase $59.8B from 2013 to 2017 (Columbus, 2013). This is the reason why telecoms like Rogers have plans to develop cloud-based hosted data analytics (Trichur, 2013), however it is still companies like IBM (and Cisco) that has been quickly establishing itself as a major player in this field (IBM, 2013). The vast amount of data in the healthcare field is being collected at a pace that is“growing and moving faster than healthcare organizations can consume it”. In fact 80% of clinically relevant medical data is unstructured and therefore nearly inaccessible for medical practitioners. Changing the way that healthcare data is stored and communicated can save lives, reduce costs and improve the overall quality of care hospitals are able to provide (IBM, 2014). ! Healthcare Canadian federal and provincial governments have recognized the degree of importance in improving the healthcare industry (Canada Institute for Health Information, 2011) and making such improvements first requires an understanding of how technology like REMS can be used to make these improvements. Because the success of REMS will depend on government support and healthcare spending in Canada, it is important to evaluate spending trends which may provide insight into possible opportunities that REMS can take advantage of. Total healthcare spending in Canada was expected to reach $207B in 2012, and continue to slow down because of budgetary deficits modest economic growth (Canadian Institute for Health Information, 2012), which is why it is even more important that the government uses funds in the most efficient way by investing in technology like REMS that is going to make the healthcare ecosystem function at an optimal level. ! ! ! ! 4
- 7. Internal Analysis Rogers Rogers CommunicationsInc. has established itself as a Canadian company by investing in the following three business lines; Rogers Cable, Rogers Media and Rogers Wireless Inc, which is Canada’s largest wireless voice and data communications service provider (Office of the Commissions of Lobbying of Canada, 2013). According to Rogers Business Resources (2014), the use of technology can be a catalyst in response to health outcomes for doctors, health practitioners and above all the patients themselves. Rogers has already invested in aspects of the healthcare industry by developing wireless applications for healthcare professionals (Rogers Business Resources, 2014). Core Competencies and Partnership Synergies As Rogers uses the IofT and M2M communication to expand its healthcare offerings beyond its mobile healthcare solutions, it will need to supplement some if its existing competencies with healthcare analytics and augmented reality hardware through strategic partnerships with industry-leading technology firms such as IBM and Google, who are also interested in making waves in the M2M-Healthcare ecosystem (IBM, 2014; Guynn, 2013). Figure 2 below displays the core strengths and weaknesses of Rogers, IBM and Google in regards to establishing REMS and highlights the synergistic potential of this partnership. Because of several acquisitions of companies like Atria Networks, Rogers has developed an extensive fibre optic and ! ! communication dissemination network, making it the leader of wireless race in Canada (Britten, 2010; Trichur, 2014), placing it in the ideal position to grow its healthcare product offerings over the next five years to incorporate the commoditization of M2M communication. It has invested heavily in owning, not renting, much of its infrastructure, and therefore has reliable access to the infrastructure necessary to physically implement REMS (Rogers Business Solutions, 2014). This also increases the security it is able to offer to its clients, as it can maintain and service its own systems and does not have to risk the possible security breaches of a third party. Rogers has already seen the potential of the M2M- Healthcare ecosystem and has started considering the virtualization of healthcare through wireless applications for healthcare professionals and wireless solutions for the healthcare industry in general (Rogers Business Resources, 2012). Rogers is one of only three major telecoms in Canada, and because of its recent $3.3B investment in 22 licences at the 700MHz spectrum auction to increase mobile video power (Trichur, 2014), and its $117B government contracts (Southern, 2010), it is an attractive partner for the government in implementing M2M- Healthcare solutions (REMS) across Canada. Though Rogers does have well established business analytics, it does not currently have the experience to analyze and utilize the approximately 80% of unstructured medical data (IBM, 2014), and in order to enable the effective use of this data within REMS,with big data healthcare analytics that IBM has, nor the expertise in manufacturing the necessary augmented reality hardware for REMS. This is where IBM and Google Glass round out the skill set necessary to make REMS a reality. ! 5
- 8. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Figure 3 showshow the strengths of the three pillars in this partnership (network infrastructure, analytics, and hardware) marry the necessary components for the creation of REMS. Rogers provides the Fibre Optic Network, expertise in privacy, and government relationships. IBM also has expertise in data security, but contributes the powerful analytics necessary, the operational cloud service, and the CDN while Google Glass provides its augmented reality wearable technology hardware. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! 6 Figure 2: Synergistic Potential of Partnership Strengths Figure 3 - The Creation of REMS IBM Rogers Google (Glass) Weakness Strength Weakness • Cloud market share (5%) is not as high as Akamai nor Amazon (Synergy Research Group, 2012) ! • Recently sold their hardware division • Infrastructure ownership • Interest in Health Care • Lobbying Power • Large fibre optic network • Security tunnels • Capital • Google Health failure (Lohr, 2011) ! • Fear of being a “one trick pony” ! • Uncertain sales predictions and popularity amongst mainstream consumers (IHS, 2013) Strength Weakness Strength • Healthcare analytics (eg. Watson) • Hyper focused on cloud service • Existing CDN • Experience and reputation • No capability for healthcare analytics ! • No wearable hardware creation competencies necessary for REMS • Product past beta phase ! • Has proven healthcare applicability ! • Intuitive, unobtrusive, portable !
- 9. REMS: Details ! REMS isan M2M solution for the healthcare ecosystem to disseminate large amounts of processed medical data to medical practitioners, in an intuitive and unobtrusive way. REMS is formed by three strategic partners and takes advantage of Google’s wearable hardware Google Glass; Rogers’ ability to provide network coverage and secure channel; and IBM’s cloud-service, healthcare analytics, and Content Delivery Network (CDN). ! Developing Philosophy REMS enables frontline healthcare workers to access processed, prioritized, and context aware information. This is important because the current system of dissemination used by e-health goes against the Technology Adoption Model (TAM) (Figure 4). Traditional user interfaces are not easy to use in the hospital setting since healthcare professionals are constantly“on the run”, and sitting down in front of a computer creates wasteful downtime. This conclusion is supported by low adoption and utilization rate of current e-health systems in Canada (which are 14%, 8% respectively), and physicians listing IT and accessibility as a major barrier to e-health’s ! ! ! ease of use (green box in Figure 4) (Anderson, 2007). REMS is developed with TAM in mind, which greatly increases the usefulness and accessibility of healthcare information . ! Conceptual framework: How is it going to work? The camera and microphone on Google Glass will provide graphical, auditory and locational inputs to proxy servers located within the hospitals via a closed-network; these servers will encrypt and compress the inputs and pass the information to private cloud-servers for data storage and analysis. Existing electronic medical record data will be used for in-depth data analysis; then the processed data will be forwarded to (IBM’s) Content Delivery Network for reliable and speedy distribution (since data size will be large). Finally, processed data will be transmitted back to the Google Glass’on- screen display as needed (graph 1). REMS algorithms and analytics provided by IBM could enable REMS to learn the habits of the user, and predict the types of information needed by interpreting 7 Figure 4: Technology Adoption Model
- 10. graphical and auditorydata, thus making unprocessed data“context-aware”. Google Glass is an optimal wearable technology for REMS because it provides an on-screen display right in front of user’s eyes, thus achieving reality augmentation by overlapping the physical world with computer generated sensory input. For example, if we use Google Glass to look at a patient, related information such as age and medical condition will appear next to the patient on the screen. Figure 5 explains activities at different levels of REMS. ! Potential application-features that can be achieved by REMS Automatically scans the environment and communicate meaningful data to the proxy server without user manipulation, truly achieving M2M 8 Figure 5: Detailed Explanation of REMS
- 11. Facial recognition forpatients to prevent identification errors Medication administration aid Electronically store traditional paper- based information Use camera to take pictures of physical forms transferred to algorithms which digitize the content (for privacy considerations) Location of key personnel during emergencies Provide medical practitioners with preemptive information ! Possible future uses As new sensors are introduced to the hospital setting, M2M communications become more valuable Bio sensors will allow doctors to have access to real time patient status More accurate bio-signature authentication will allow doctors to enter medical orders wirelessly ! Security and Privacy REMS uses a closed-network between Google Glass and proxy servers, and employs a private cloud system between those servers and IBM’s data centre. These two infrastructure choices will minimize the risk for accidental data loss. Fibre optics cables provide additional data transfer security, because photons are very difficult to be intercepted and decoded. Even in the case of data-tapping, the immediate cessation of light signals due to exposed wire will warn cable providers of leaks (Thyagarajan & Ghatak, 2007). In addition, encryption measures through the Wireless Application Protocol 2, and secure network channels provided by Rogers will effectively prevent external data theft (Wexler, 2010). As for internal data security, Google Glass has the capability to use bio-signatures such as unique ECG- waves or fingerprints to authenticate users instead of the traditional password method (Dvorsky, 2014). For patients and doctors, privacy may be a more immediate concern in comparison with data security, because of the video and audio monitoring nature of REMS. However, with the increasing prevalence of surveillance cameras, mobile device location tracking, and social networks, there may be less resistance to REMS technology today and into the future than there was even 10 years ago. The benefits of REMS far outweighs its potential drawbacks, as long as the appropriate security measures are taken to ensure data safety. ! Revenue Model & Financial Projection ! There are three standard revenue models available for Rogers: (1) enterprise hardware sales of Google Glass as contracts (2) on- demand fee schedules for network and proxy server usage, and (3) maintenance and implementation fees. All three should be used in conjunction to amortize initial capital investment from the hospital, because surveys have shown that financial restraints were the number one concern for 9
- 12. hospitals when e-healthwas implemented in Canada (Anderson, 2007). ! ! ! ! ! ! ! ! ! ! ! ! Financial projections indicate that upon the deployment of REMS, Rogers will generate $46M gross profit and a 49% gross profit margin (Appendix 1). $4.6M will be derived from carrying Google Glass; $37.6M from providing network and intermediate servers; $7M from on-going maintenance fees and implementation fees (Figure 6). ! We approximated 4 major variables in our financial projection: a) the cost-structure of REMS for Rogers; b) the wholesale and retail price for Google Glass; c) benchmarked profit margin from each revenue models; and d) the market size for REMS (according to the number of healthcare professionals, hospitals’potential cost-savings, and percentage of initial adopters). A detailed explanation and reference for these estimations can be found in Appendix A, along with market growth rate predictions, and the effects of economy of scale. ! ! ! ! ! ! ! ! ! ! ! ! ! ! Buy-in for Stakeholders ! ! From Figure 2, it is clear that Rogers has strong bargaining power in the value chain of REMS. REMS can provide Google Glass and IBM exposure to the emerging profitability in the M2M-Healthcare ecosystem that makes use of all three firms’ core competencies. However, IBM and Google Glass are not the only stakeholders that need to be considered when generating buy-in. Hospitals, medical practitioners and the government must all be consulted and sold on the idea of REMS, and why it will work for them. One of the major benefits for hospitals to invest in this project is the access to care will increase allowing patients to be dealt with in a quick and effective manner ultimately reducing costs. The Canadian Medical Association recognizes the high costs 10 Figure 6: Financial Projection for REMS
- 13. associated with excesswait times. The cumulative economic cost of waiting for treatment in 2007 was estimated at $14.8B (The Centre for Spatial Economics 2008). Among other improvements, incorporating REMS into the healthcare ecosystem can reduce wait times by making doctor-patient interactions more efficient, and in turn, contribute to reducing overall costs. Another benefit of REMS for hospitals is the reduction of diagnostic error. Studies have shown that an electronic medical record that facilitates computerized physician order entry can significantly prevent serious medication errors, and electronic prescribing has been shown to reduce prescription errors and improve compliance with managed care formularies (Anderson, 2007). The Canadian government has faced extreme obstacles in the communication and uptake of e-health by medical practitioners (Canadian Medical Association Journal, 2011). There is an urgent need to create value out of the e-health debacle, and it has been noted that“the future of e- health...will be driven by consumer-friendly innovations such as the tablet and the consultation application”(Magazine, 2012). REMS is the next step in healthcare. It tackles the problem by using a cloud service where doctors and hospitals are able to input and extract information from a network that is flexible, cost effective and intuitive. ! ! ! Implementation ! ! Pre-Execution tasks Phase 0 starts in July, 2014 and is planned in 3 stages (see Gantt Chart in Appendix B): Stage 1) Conducting in-depth market research, drafting and prioritizing partnership models, legal considerations, initial negotiations with partners, government lobbying, and perfecting the business plan and business model Stage 2) Rogers finalizes partnership and revenue/responsibility split, sales model (incorporate exclusivity contracts both with partners and hospitals), receive necessary government approval, adapt Rogers’Health Division. Stage 3) Partners customize their product/ services, prepare for the pilot project Pilot project (Stage 4) The execution phase starts with a pilot project with limited scope, in conjunction with the development of a training program for future REMS users. The pilot project will take place in one or two hospitals with minimum system setup requirements, and REMS (with limited features and capabilities) will be tested by healthcare professionals as users. The feedback generated by this phase will be crucial in fine tuning REMS before its full scale launch. ! ! ! ! 11
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- 17. Appendix ! ! 15 Appendix A: FinancialProjection
- 18.
- 19.