What Healthcare Can Learn From Mobile Interoperability.
Avoiding proprietary technology lock-in.
I was fortunate to be part of the founding team of Symbian, the British mobile software platform company behind the first global smartphone operating system, reaching 90% of the world’s handset manufacturers and shipping over 100 million phones. But that didn’t happen without getting some significant war wounds in the process (Note 1). I believe that some of the lessons learned back when the mobile industry was at its inflection point can help inform decision makers facing similar challenges in healthcare.
Before Symbian got traction, my team and I reasoned that to enable a new class of devices that could do so more than make phone calls, there was a need for a standardized mobile ecosystem that not only engaged consumers but also drove network operators’ Average Revenue Per User (ARPU). Otherwise, the network operators wouldn’t be motivated to support the new devices. To achieve our mission, we had the unenviable task of convincing the mobile industry incumbents that proprietary devices and networks needed to give way to interoperable solutions and open standards. “Good luck with that” was the sentiment at the time, so nothing new there. Although the technology and business logic were obvious to us, it wasn’t an easy sell.
We had the unenviable task of convincing the incumbents that their proprietary devices and networks needed to be interoperable. “Good luck with that” was the sentiment at the time, so nothing new there.
A specific example of network operators’ thinking at that time, was their approach to text messaging, which couldn’t be used across different US wireless networks. The market leaders used proprietary systems to keep their customers locked into their networks. If you were a customer of AT&T (then known as Cingular Wireless), text messaging was a feature for their subscribers only. AT&T reasoned that they could attract new subscribers with proprietary text messaging, and then make it very difficult for them to take their phones or accounts to other networks.
This proprietary lock-in approach is very short sighted and obviously hurts the customer but also eventually hurts the network. Users can’t connect to everyone they want to connect to, so over time, Average Revenue per User declines, and networks fail to maximize user engagement and value.
We know how this played out; the industry recognized the potential and demand for interoperability and established global standards that allowed users of different networks to send and receive messages to each other as well other services. Text messaging grew to 2.52 billion people sending over 23 billion texts every day (Note 2).
The above story is only one example of the short-term folly of walled gardens in technology. America Online, CompuServe and Prodigy vied to lock customers into their respective solutions before web browsers enabled application data to flow easily across networks and web utilization took off. There are many other examples of incumbents slowing down the inevitable march of standards and interoperability.
I am confident that history is repeating itself in healthcare where software solutions and devices that are not interoperable are, at best, only viable in the short term, and ultimately can be expensive mistakes that end up siloed. Users (healthcare professionals as well as patients) effectively pay a “proprietary technology tax” and face the same expensive consequences of lock-in as the above examples demonstrate.
Proprietary technology vendors will try to guard their walled gardens, creating technology fragmentation and posing challenges for integration with expensive engineering fees and switching costs. But as in other markets, that strategy is unsustainable. Consumer expectations are evolving towards more open and interoperable systems. This is especially true where “Digital First” experiences are positioned to leverage interconnected devices and services with plug-and-play simplicity and freedom of choice.
As recognized by the American Telehealth Association (ATA) (Note 3), Telehealth is just one example where interoperability could dramatically enhance existing proprietary solutions, opening up access to patients that are currently unable to be examined remotely due to a lack of compatible devices and/or open standards.
Interoperability and open standards in healthcare will better enable the aggregation and analysis of data from various devices and software systems, that in turn will help providers see patterns in the information that would otherwise be buried inside closed devices. This approach can then lead to better patient outcomes as well as well as more efficient economics and workflows for the entire ecosystem. Just as cross-platform technologies drove both data revenues and customer engagement in the mobile industry, strategies that focus on interoperability rather than proprietary technology, will similarly empower healthcare providers to deliver more valuable, effective and efficient patient-centric care.
References and further reading:
1. Symbian, The Secret History: https://www.theregister.com/2010/11/23/symbian_history_part_one_dark_star/?page=2
2. The Past, Present And Future Of Messaging: https://www.forbes.com/sites/forbestechcouncil/2021/01/06/the-past-present-and-future-of-messaging/?sh=47e5e0cb9f17
3. The state of interoperability in Transforming Healthcare. March 2023 ATA: https://gotelehealth.org/ata-2023/sessions/the-state-of-interoperability-in-transforming-healthcare/