Health Care Emerging WiMax (Senza Consulting)

Expanding the Reach of Health Care in
Developing Nations with WiMAX
How Wireless Connectivity Can Improve the Quality and
Efficiency of Health Care

Monica Paolini
Senza Fili Consulting
April 2, 2009

Developing nations face urgent challenges in improving
access to and the effectiveness of their health care
systems with very limited financial and human Table of contents
resources. With technologies like Worldwide
Interoperability for Microwave Access (WiMAX), Improving quality of and access to affordable
wireless broadband connectivity is set to play a growing health care ...................................................................... 1
role in meeting the World Bank goals of increased The advantages of wireless technologies ....................... 1
affordability and efficiency of health care in developing Why WiMAX? .................................................................. 1
nations. WiMAX brings real‐time wireless broadband Empowering health workers through training ............... 1
connectivity to remote and mobile workers, clinics, and Better intelligence about the environment .................... 1
hospitals and has the potential to greatly increase Reaching cost efficiencies ............................................... 1
access to and quality of health care, expand the Conclusions ..................................................................... 1
availability of training to the health care workers, and
improve epidemiological and demographic data
collection.

WiMAX provides secure, real‐time connections to support voice, data, and video applications, in both fixed and mobile
environments. It allows health care workers to have access to patient records and medical reference information, to
send their colleagues test data to be analyzed, to rely on specialists for guidance or remote consultations, and to have
access to online, video‐based training. Patients are empowered with more comprehensive health care services provided
by nurses and doctors they know and trust, with wider access to information and education, and with more extensive
preventive care. Lower equipment costs and cooperation with operators make adoption of wireless broadband
affordable in developing nations. Successful adoption of services requires supportive policies and a willingness to
experiment with new business models in which public and private organizations can mutually benefit from cooperation.

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© 2009 Senza Fili Consulting • www.senzafiliconsulting.com | 1 |

White Paper Expanding the Reach of Health Care in Developing Nations with WiMAX

drive), or ambulances. A wireless broadband connection
can also support basic voice services that can be made
accessible to the staff through low‐cost Wi‐Fi phones.
Improving quality of and access
to affordable health care In sparsely populated areas in Ontario, Canada, more
than 32,000 remote video consultations per year with
specialists improve health care access for residents
Bringing health care where it is needed. Today, visiting local clinics. According to Cisco estimates, they
patients have to travel to the closest clinic or hospital to save US$8 million in medical‐related travel costs per
receive basic treatment, and to more distant year.
institutions for specialized or emergency care or for
hospitalization. This model does not provide The government of India has adopted an ambitious plan
comprehensive and efficient access to health care in to roll out mobile clinics in rural areas to offer
developing nations. With 56% of the population in 2007 telemedicine and e‐education applications 4 . Each local
living in rural areas1 , some of which are not reachable health center relies on mobile clinics to reach remote
by road, ill patients often lack the time and resources to patients. Volunteers are recruited in each village to
reach the closest clinic. In urban areas, one third of the coordinate health care activities and monitor for early
population lives in slums2 where clinics are few, signs of epidemics and for other situations that require
overcrowded, and poorly funded.   immediate attention. Access to data connectivity is
crucial to volunteers, who typically have no medical
Reliable, always‐on broadband wireless connectivity training; it enables them to send data or photographs or
makes a new health care model possible: instead of arrange for video calls to exchange information and get
asking the patient to go to the nearest clinic or hospital, guidance.
the mobile health care worker reaches out to the
patients where they live and when they need care, In Pakistan, Cisco is working on a trial that combines
bringing access to a broad set of medical resources satellite and WiMAX connectivity to mobile units that
through voice, data, and video applications.   provide earlier oncological screening to rural patients.
Female patients feel more comfortable seeking care in a
Reaching out to remote health care workers and familiar environment, close to their homes. Earlier
clinics. In addition to the individual mobile health care screening allows doctors to detect breast cancer in
worker, WiMAX networks can provide a data women when it is still treatable.
connection to a variety of health care facilities: local
clinics that do not have wireline broadband
connectivity 3 , mobile clinics (e.g., hosted in buses) that
operate in multiple locations, temporary clinics that “Information and communication technologies
may be set up for a specific purpose (e.g., a vaccination enable people in remote areas to have access to
services and expertise otherwise unavailable to
                                                        them, especially in countries with uneven
1
United Nations, 2007. In the least developed countries, the number is 72%. distribution or chronic shortages of physicians,
2
United Nations Population Fund, 2007. In the slums of Nairobi, access to
nurses and health technicians or where access
health care is even more limited than in rural areas. The infant mortality rate is to facilities and expert advice requires travel
20% higher there and immunization levels are 25% lower, according to the over long distances,” World Health
United Nations Population Fund Africa Population and Health Research Center Organization, 2008.
(2002), Population and Health Dynamics in Nairobi’s Informal Settlements.

3 4
According to Dr. Gregory Cline, Healthcare Business Development Manager Ministry of Health and Family Welfare, India (2005) National Rural Health
at Intel, in South Africa almost 95% of rural clinics still lack voice connectivity. Mission.

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Bringing health care closer to the patient: Faster, less wasteful, more dependable health care.
what are the gains? “Real‐time wireless broadband access to collected data,
reference information, and colleagues increases the
Improved health levels among the population, depth of expertise available at the point of care, making
translating into longer life expectancy, improved the patient examination more effective and reducing
quality of life, and increased work productivity5 . the need for referrals and hospitalization,” according to
Dr. George Margelis, Health Industry Development
Reduction in waste of resources due to unnecessary Manager at Intel.
referrals and hospitalization6 or to late intervention, in
turn reducing funding needs. A trial in rural Niger 8 showed that a wireless link from
rural health centers to the hospital to coordinate
Quicker and more effective response to epidemic
ambulance calls improved access to emergency care.
outbreaks.
Over seven years, the annual number of emergency
Increased trust in and reliance on the health care patient transfers to hospitals increased from 59 to 352.
network by underserved communities, thanks to In addition, the number of cases that could be resolved
closer ties to health workers. According to a 2008 at home or at the local clinic increased from 25 to 45. All
report by the World Health Organization, “Access to operating costs and 50% of initial capital costs were
the same team of health‐care providers over time recovered within six years. The addition of real‐time
fosters the development of a relationship of trust video communications will enable ill patients to get a
between the individual and their health‐care preliminary assessment of their condition and use that
provider.”7 to establish with more accuracy whether ambulance
transport is warranted.
More extensive access to preventive care for patients
who do not require hospitalization or specialist visits. Efficient use of limited resources. In developing
nations, one of the most pressing issues is the limited
Higher satisfaction on the part of mobile and remote
availability of resources. According to the World Health
health care workers who are empowered by increased
Organization, there are 2.3 health care workers per
responsibility and accountability, a closer integration
1000 people in Africa, compared to 24.8 in the
into the medical community, more extensive learning
Americas. Furthermore, the percentage of highly
opportunities, and the increased efficiency and
trained health workers is typically lower in developing
visibility of their work.
nations. The nurse‐to‐doctor ratio is 8:1 in Africa, versus
4:1 in the USA and Canada. The World Health
Organization has identified 57 countries with an
insufficient health care workforce, a shortage that totals
2.4 million health care workers (Figure 1).

5
In Nepal, a study found that community‐based health care assistance
Wireless broadband connections enable telemedicine
reduced neonatal death (from 36.9 to 26.2 per 1000 births) and maternal
death (from 6.9 to 3.4 per 100,000 births) [Manandhar D.S. et al. (2004) Effect applications to improve the workflow and the
of a participatory intervention with women's groups on birth outcomes in management of resources, and leverage existing
Nepal: cluster‐randomised controlled trial. Lancet 364(9438):970‐9]. resources to treat a larger number of patients. Many
6 remote clinics may have equipment to perform tests,
The World Health Organization 2008 Report quotes a study that shows that a
higher reliance on primary care could avoid 50% of hospital admissions in Latin
but no specialist to interpret the data. In a trial in
American countries.
8
Bossyns, Paul et al. (2005) Unaffordable or cost‐effective? Introducing an
7
World Health Organization (2008). Primary Health Care—Now more than emergency referral system in rural Niger. Tropical Medicine and International
ever. The World Health Report 2008. Health. 10(9):879‐887.

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Afghanistan by Roshan, a telecommunication service
provider, and Cisco, remote clinics with X‐ray Establishing priorities
equipment but with no resident radiologist were able to in rolling out WiMAX applications
have their X‐ray scans quickly interpreted by specialists Phase 1: Voice and data connectivity are “the basic
at larger hospitals and promptly act on the diagnosis. requirement, to ensure that mobile workers have
access to clinical decision support, patient records, and
In an Intel‐sponsored trial in India, “wireless voice and reference information,” according to Mark Blatt,
data communications have reduced the time to Director, Healthcare Industry Solutions at Intel.
transmit select patient clinical data in a remote location,
taken by a nurse and its subsequent analysis and Phase 2: In dealing with patients with limited literacy,
reporting by a specialist in a tertiary care hospital, to who often primarily speak a language different from
less than 15 minutes,” according to Ashok the one the doctor speaks, video applications can
Chandavarkar, APAC Healthcare Programs Manager at dramatically improve the richness and effectiveness of
Intel. Real‐time data and video connectivity will further the exchange9 . Broadband connectivity also enables
improve the coordination and the information or enhances remote consultations with specialists.
exchange between ambulances and hospitals.
Real‐time video applications can also support e‐
education initiatives that encourage patients to
participate via interactive formats. These videos may
be hosted at clinics or accessed from home.

Phase 3: Patient‐driven applications can eventually be
introduced to empower patients to take a more active
role in requesting care, accessing their records, and
sending in data (e.g., insulin levels, blood pressure)
directly to health care providers. These applications
require high broadband penetration levels and
extensive coordination among health care agencies, so
we expect them to become available in the long term.
Figure 1. Countries with a critical shortage of health care workers.
Source: World Health Organization. The World Health Report 2006


"Even if you have the medicine, the vaccines, and
the bed nets, you need the health workers to
deliver the service. With the experience of the
last few years, where you have had huge global
funds move into an activity to provide resources
. . . we've found that the bottleneck is really the
delivery," Dr. Manuel Dayrit, Director of the
Department of Human Resources for Health at
the World Health Organization, 2006.


9
Jonsson, Ann‐Marie and Willman, Ania (2008) Implementation of telenursing
within home healthcare. Telemedicine and e‐health, 14(10): 1057‐1062.

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The advantages of wireless technologies
Multiple telecommunications technologies are required in order to provide the real‐time availability, security,
and performance that telemedicine applications need. WiMAX is well suited to providing connectivity to mobile
workers and to remote and temporary clinics. Within hospitals and large clinics, Wi‐Fi and WiMAX may both be
used to provide connectivity to mobile devices like laptops, tablets, or VoIP phones being used by health workers
at that location. Cellular and satellite technologies provide good wide‐area coverage, but they are expensive and
cannot support bandwidth‐intensive applications such patient imaging data uploads or remote video
consultations.

The traffic from Wi‐Fi and WiMAX networks may be backhauled by a wireless link, which can use WiMAX or
another wireless interface, or by fiber or another type of wireline connection, if available and cost effective.
Eventually, backhaul traffic is ported to a fiber optic link and to the Internet. At the other end, a hospital or a data
center may receive the data and voice traffic through either a wireless or a wireline connection.

For mobile workers, a wireless broadband connection is necessary to provide real‐time communications with
clinics, hospitals, and data centers. Wireless connectivity may also be used at fixed locations (e.g., rural clinics) as
a substitute for wireline connectivity where a wireline broadband connection is not available, is too expensive, or
does not provide sufficient bandwidth.

In many developing nations, such as India, there is a trend towards deploying wireless technologies like WiMAX
in lieu of expanding wireline technologies. Wireless equipment is easier to secure, is faster and cheaper to
deploy, and does not require the use of copper or other material that frequently becomes the target of theft.
Countries like India and Kenya, which have good countrywide fiber backbone infrastructures, are well positioned
to build wireless networks with coverage extending into rural areas, because the wireless traffic from villages can
be cost‐effectively backhauled to data centers.

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Why WiMAX?
WiMAX is a high‐performance, cost‐efficient technology that is set to make wireless broadband widely available
and affordable. It is particularly well suited to meet the challenges of developing nations to bridge the digital
divide, to provide fixed and, increasingly, mobile access to their citizens, and to support a wide range of
government, healthcare, education, and enterprise applications. WiMAX supports both mobile connectivity
through laptops, tablets, netbooks, phones and other devices, and fixed connectivity through desktop modems
or outdoor Customer Premises Equipment (CPE). South Korea, the USA, India, Russia, and many developing
nations already have operating WiMAX networks.

Among the key benefits WiMAX brings to telemedicine are:

True broadband connectivity (2–4 Mbps in the downlink, 0.5–1.5 Mbps in the uplink) to enable transfer of
large data files and video applications. In cellular networks, uplink speeds are typically substantially lower,
slowing down transmission from the mobile workers back to the hospital. WiMAX performance is achieved
by using a new wireless interface with high spectral efficiency, and by using wider channels that can increase
the overall network capacity.
IP‐based technology, which brings lower complexity and costs in managing the network, facilitates the
development of new applications or the adaptation of existing applications, and can be easily integrated
within existing networks.
Carrier‐grade reliability and security, due to the use of licensed spectrum and IP core network technology.
WiMAX supports multiple Extensible Authentication Protocol (EAP) methods, Remote Authentication Dial In
User Service (RADIUS), Diameter, Advanced Encryption System (AES), and Privacy Key Management Protocol
Version 2 (PKM v2). Security is crucial to ensure protection of patient and epidemiological data.
Quality of Service (QoS) and traffic prioritization mechanisms, to give priority to latency‐sensitive
applications such as voice and video. This increases the robustness of numerous telemedicine applications
that rely on voice and video traffic.
Lower cost‐per‐bit than cellular networks. This makes the technology affordable for network operators to
deploy and for health care providers to use for telemedicine applications.
A wide range of devices with WiMAX chipsets embedded along with Wi‐Fi, at a very low additional cost. This
gives health providers greater flexibility in choosing the best‐suited devices that are within their budget.
WiMAX may initially be used mainly as a backhaul technology to provide basic data and voice connectivity to
clinics. At a later stage, mobile applications will take on a larger role as network coverage, low‐cost devices, and
mobile telemedicine applications become available.

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Choosing the right mobile device
Empowering health workers
The choice of mobile devices is crucial to acceptance by
through training health workers. In nearly all cases, powerful devices are
not needed, as they are used mostly for entering and
Ongoing training is essential to motivating and viewing data, accessing the Internet, or streaming video.
empowering health care workers, and to improving the Dr. Cline points out that “Experience from early trials in
quality of care, but it is difficult and expensive to Africa indicates that the devices should have screens of 9
provide. Training is especially challenging for remote inches or more to display photos and videos at the
and mobile health care workers, who may need to take required resolution, have an effective, easy‐to‐use and
time off from work, and travel to the training location. yet powerful user interface, especially for data input,
In some cases, suitable training locations may not be and be comfortably carried around.”
available. In a trial in India, Cisco and Intel used wireless Devices like Personal Digital Assistants (PDAs) can be too
connectivity to send e‐learning classes to laptops that small for most tasks, while health care workers may find
students were able to afford thanks to government more powerful but bigger and heavier laptops
subsidies. overwhelming. In many cases light laptops or netbooks
are attractive solutions because health workers—and
Many health care workers in developing nations have
doctors especially—are already familiar with the form
received limited training in school. Volunteers may have
factor.
no medical background and limited literacy. Dr. Gregory
Cline, Digital Health Business Development Manager at Devices like the Classmate PC currently being developed
Intel in South Africa, says “Training modules have to be by Intel promise to make the familiar laptop and sub‐
short (less than 20 minutes) and simple, and be laptop form factor affordable in developing nations. It is
accessible anytime, anywhere to be effective.” equipped with a camera and a detachable keyboard, and
has a ruggedized but lightweight format that is well
Wireless connectivity can provide a powerful boost to suited to health care workers.
training for health workers, by providing remote or
home‐based learning opportunities, such as: “These devices can also be shared with others, and this
raises their perceived value,” according to Debra Sloane,
Access to documents that describe best‐practice Global Healthcare Solutions Partner Manager at Cisco.
procedures, or that provide reference information. For instance, the laptop that the nurse uses at work
during the day can help her children complete their
Download of presentations in slide, audio, or video homework at night. In some countries (e.g., China,
format.   Ghana, India, Nigeria, Turkey), governments are
Classes for credit that are managed over the developing or have already introduced subsidy models
Internet, with lectures, assignments, and contact to encourage ownership of mobile devices, like laptops,
with instructors through VoIP, email, or messaging. that can be shared by family members.

Real‐time participation and Q&A sessions in In the health care environment, this enables workers to
presentations and classes using video or audio have their own device, rather than having access to a
streaming.   pool of devices that may or may not be reliably available.
It will also make health care workers more committed to
Training on telemedicine applications, which is a
learning how to use mobile devices proficiently, and to
key factor in their successful long‐term adoption.
making them essential tools in their daily tasks.
Dr. Cline warns that “lack of sufficient training may
result in resistance to a new telemedicine
application.”

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Broadband connectivity is necessary for the large files
or audio/video streaming that e‐training often requires. “Improvement in the health outcomes in the
In particular, video training is much more effective than rural areas is directly related to the availability
static documents or audio training in conveying rich of the trained resources there,” Ministry of
information to volunteers or nurses whose medical Health and Family Welfare, India, National Rural
training is more limited, and who may have limited Health Mission, 2005.
familiarity with the language used by the instructor.

The Mexican government sponsored a trial to provide
training to 5,000 nurses as part of their Mobile Health
Workers for Community Outreach program. During the Better intelligence about the
initial phase, increased worker efficiency resulted in
improved patient data capture and accuracy. In further
environment
stages, the introduction of real‐time, on‐demand
training programs requires broadband connectivity. Improved health care depends on timely, effective
WiMAX is ideally suited to support these training monitoring and data collection to identify the
applications reliably and cost‐effectively. emergence of epidemic outbreaks and other health
threats, monitor environmental and health trends, or
“The Mexico trial shows how a public and private simply keep track of a population’s health.
partnership can develop a sustainable, scalable business
model which brings broader, affordable access to health In tracking epidemic outbreaks, time is of the essence.
care services to the population,” Melitta Remington, The ability to promptly identify an outbreak makes it
Digital Health Group Strategic Market Development possible to enact preventive measures that can contain
Manager EMEA at Intel, says.   or stop an epidemic outbreak (Figure 2). Timely
information can also counteract unverified information
Mobile health care workers also need assistance in that may be circulated on the Internet.
identifying the appropriate resources to which to direct
their queries (e.g., who is the best specialist to consult) Knowledge of a threat after the epidemic has spread
or their patients (e.g., what is the best clinic or hospital has limited value in containing its effects. Yet this is
to go to for a specific surgery). Peter Drury, Director, exactly what health officials have when data collectors
Connected Health, Emerging Markets at Cisco, says that need to initially record all information on paper and
“Wireless broadband will dramatically increase the then transcribe it into digital format. With wireless
availability and usefulness of communication tools like broadband, environmental or patient information can
the Map of Medicine, 10 which give health workers be entered directly into databases that track population
access to reference medical documentation and to data trends. The increasing adoption of XML‐based,
location‐specific information to assist them in standardized formats facilitates sharing of information
identifying the relevant questions and the best course among government agencies and international
of action.”   organizations.

Wireless connectivity also enables the collection of
photographic, audio, and video data to provide
increasing detail, and to facilitate further analysis. Any
sample collected can be automatically linked to Global
Positioning System (GPS) location‐based coordinates to
                                                        improve the consistency and power of data analysis.
10
http://www.mapofmedicine.com

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Cisco's WiMAX Solution
WiMAX Forum Certified
Commercial service in five continents
End‐to‐end all‐IP Cisco network
Low cost of deployment and operation
Data, voice, and video with Quality of Service (QoS)
Fixed, portable, and mobile service
Adaptive Beamforming for better
coverage, throughput, and building penetration
MIMO for higher connection speed and link reliability

Governments and telecommunication regulators play
an important role. “Making affordable spectrum
available for wireless broadband services and awarding
it to operators committed to wide deployments that
reach rural communities is a critical success factor,”
according to Paul Sergeant, Senior Manager, WiMAX
Marketing at Cisco. For example, spectrum in the
2.5 GHz and 3.5 GHz bands is reserved in many
countries for wireless broadband deployments, often
Figure 2. Impact of early detection in epidemics and cost of past targeted at underserved areas. Increasingly, lower
epidemic outbreaks. Source: World Health Organization
frequencies, especially in the 700 MHz band, are also
being allocated to wireless broadband services. These
frequencies are especially attractive in rural
deployments because lower frequency increases the
area covered by a single base station, thus drastically
Reaching cost efficiencies cutting the cost of providing coverage.

Can developing nations, operating under tight financial Taxation and certification can also have a large impact
constraints, afford to implement telemedicine on infrastructure rollouts. High infrastructure costs
applications that require wireless broadband? Currently drive increases in the cost of services provided, yet
the focus of activity is on trials to showcase the many developing nations impose high tax rates and
effectiveness of the applications. However, no matter strict certification requirements on imported
how successful the trials are, wide‐scale deployments equipment and devices, which may double the price
have to be made affordable to become reality.   tag.

Enabling deployment of wireless broadband networks. Taxes and certification requirements on imports are
A crucial area where cooperation is needed is the often introduced to encourage the growth of local
deployment of the WiMAX infrastructure to host the manufacturers. However, in an industry where volume
telemedicine applications. WiMAX networks are being is the key to low‐cost, technologically advanced
built, but the coverage is still limited in most countries. equipment, protecting local manufacturers that lack
In particular, coverage in many regions has yet to be scale often results in a restricted range of equipment
extended to rural communities. commercially available and delays the introduction of
new technologies.
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Leveraging wireless connectivity to improve care: what are the requirements?

The wireless connection has to support throughput speeds that can accommodate transfers of large
data files both in the uplink and the downlink. Health care workers need to be able to transfer high‐
resolution photos or other data in real time so they can get feedback from doctors during examinations.
Store‐and‐forward data transmission, in contrast, causes delays in care, and increases the likelihood of a
second visit.

Privacy and security are key issues when dealing with medical and epidemiological data and patient
records. Data has to be stored securely on the mobile devices, and access to the data has to be
monitored. Data transmission from the mobile device to the data center has to be secured end to end
with robust Authentication, Authorization, and Accounting (AAA) methods to verify the identity of the
transmitting and receiving devices, to ensure they are granted the appropriate privileges, and to block
unauthorized access.

The latency of the wireless link has to be sufficiently low to support VoIP connectivity. VoIP phones can
provide affordable voice services in clinics where traditional voice connectivity is unavailable or
expensive. Mobile workers often have cellular phones, but the charges for calls are often quite high. This
may discourage extensive consultations among colleagues.

While data and voice services are the most immediate requirements for enabling telemedicine
applications, video connectivity greatly enhances their value and functionality, especially with health
care workers who find interactive, highly visual instruction more compelling and easier to understand.
Good‐quality video—in terms of resolution, frames per second, and number of dropped frames—is also
needed for remote consultations. A low‐resolution video may not be sufficient for a remote doctor to
reach a diagnosis or for an instructor to show students how to complete a procedure or assess what they
observe visually about patients’ conditions.

Both clinics and mobile health care workers need affordable connectivity, with service plans that either
are flat‐fee or have large traffic allowances, to encourage frequent use of the connection. With constant
use, health care workers become more comfortable with telemedicine applications, and learn to use
resources more effectively.

Some telemedicine applications are time critical or sensitive to time delays (e.g., voice‐ and video‐based
applications). When there is competition from multiple applications for the same network resources,
QoS and prioritization of access are required to ensure that time‐sensitive applications have preferred
access to the network. For instance, a large file upload that does not require immediate attention may be
postponed or slowed down to ensure that a video call between staff in an ambulance and at the
emergency room can go on without interruption.

A successful adoption of telemedicine applications among health workers requires their enthusiastic
support. Without it, the risk is that the new devices will be relegated to drawers and fail to generate the
needed communitywide support. If used by only a small subset of workers, most applications quickly
become irrelevant, because they fail to be a gateway to resources available. Training and ongoing
support are crucial to ensure that telemedicine applications become an integral part of health workers’
daily tasks.

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New business models. “Extensive cooperation among enable a wide range of telemedicine applications that
public agencies, health care providers and operators is require a combination of data transfers, voice services,
necessary for the creation of new business models that Internet access, and video downloads and streaming.
can address the specific needs of communities,”
according to Sloane.   Broadband connectivity gives health care workers real‐
time access to reference material and patient records,
Wireless networks tend to be initially deployed in high‐ and creates a stronger link with the wider medical
density urban areas and in suburban business areas, community. As a result, patients get better access to
where their highest‐paying subscribers are. health care and improved quality of care, increasingly
Governments, health care agencies, and Non‐ provided right where they live. Health care workers can
Governmental Organizations (NGOs) need to work receive more extensive and effective training and are
together with network operators to ensure that empowered to make treatment decisions at mobile and
operators see a business opportunity in underserved remote points of care, avoiding unnecessary referrals
urban and rural areas.   and hospitalizations. Real‐time connectivity also
streamlines the collection and analysis of population
In some cases, governments may provide some funding data, enabling earlier preventive action to contain
towards the network deployment. Increasingly, private‐ epidemic outbreaks.
public partnerships ensure long‐term mutual support.
For instance, government agencies may become anchor WiMAX promises to bring technologically advanced, but
tenants by agreeing to purchase services from the affordable broadband connectivity to developing
operators in exchange for a commitment from the nations, including underserved urban and rural areas.
operator to build and operate the network.   WiMAX will be instrumental in closing the digital divide
and in achieving global competitiveness in developing
To ensure long‐term sustainability, it is essential to nations.
place telemedicine applications within a wider context
of applications that may be related to education, “Technological advances allow WiMAX to make a more
training, government services, financial services, efficient use of spectrum and equipment resources than
entertainment, and support for local small businesses. A wireless technologies currently deployed,” Sergeant
single application segment, e.g., telemedicine or says. In addition to health care applications, WiMAX
education, is typically not sufficient to justify a network supports fixed and mobile broadband access and VoIP
expansion. A wide range of applications concurrently telephony to support local businesses, training,
deployed by multiple public and private entities community‐based and government applications, and
presents a stronger business case to operators assessing Internet‐based commerce.
the opportunity to deploy their networks in
underserved areas.   To accelerate the deployment of WiMAX networks,
governments, NGOs, and health care providers need to
work together to establish partnerships with the
operators that deploy and operate WiMAX networks.
To ensure a cost‐effective, affordable rollout of
Conclusions telemedicine applications, it is crucial that they become
part of a wider ecosystem that is aimed at improving
Wireless broadband technologies like WiMAX can bring the quality of life and the economic productivity of
reliable and secure connectivity to individual mobile communities and that may include fields such as
health workers, and to remote and mobile clinics. They education, training, and government that also stand to
greatly benefit from wireless connectivity.

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Acronyms
AAA Authentication, Authorization, and PDA Personal Digital Assistant
Accounting PKM v2 Privacy Key Management Protocol Version 2
AES Advanced Encryption System QoS Quality of Service
CPE Customer Premises Equipment RADIUS Remote Authentication Dial In User Service
EAP Extensible Authentication Protocol VoIP Voice over Internet Protocol
GPS Global Positioning System WiMAX Worldwide Interoperability for Microwave
IP Internet Protocol Access
NGO Non‐Governmental Organizations

About Senza Fili Consulting

Senza Fili Consulting provides advisory support on wireless data technologies and services since
2003. We assist vendors in gaining a better understanding of the service provider and end user
markets. We work alongside service providers in developing a wireless data strategy and in
assessing the demand for wireless services. Independent advice, a strong quantitative approach,
and an international perspective are the hallmarks of our work.

At Senza Fili we have in‐depth expertise in financial modeling, market research, business plan support, business
development, RFPs and vendor selection support, due diligence, white paper preparation, and training. Our clients are
international and span the entire value chain: they include fixed and mobile operators, ISPs, greenfield operators,
vendors, solution providers, system integrators, investors, and industry associations.

For additional information you can visit us at www.senzafiliconsulting.com, or you can contact us at
info@senzafiliconsulting.com or at +1 425 657 4991.

© 2009 Senza Fili Consulting, LLC. All rights reserved. This white paper was prepared on behalf of Cisco Systems Inc. and Intel
Corporation. The views and statements expressed in this document are those of Senza Fili Consulting LLC, and they should not be inferred to
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Fili Consulting LLC makes no warranty, express or implied, as to the accuracy of the information in this document. Senza Fili Consulting
assumes no liability for any damage or loss arising from reliance on this information. Trademarks mentioned in this document are property of
their respective owners. Cisco, the Cisco logo, and Cisco Systems are trademarks or registered trademarks of Cisco Systems, Inc.

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