Bluetooth protocol gets serious nibbles from vendors lured by visions of wireless

Despite the virtual nature of data, usage has long been tied to physical forms of communication-paper, phone lines, cables, floppy disks, and the like. But the emerging wireless infrastructure has the power to make data more dynamic and communicable than ever before. Many vendors regard the nascent Bluetooth protocol as the key to making wireless capability a necessity rather than a luxury in both consumer and business markets. Even healthcare has been flirting with tighter integration of wireless technologies into the clinical workflow to improve the delivery of critical data to the point of care.

What exactly is Bluetooth? Named for 10th century Danish king Harald Bluetooth, it is a short-range wireless interface technology that transmits in the unregulated 2.4 GHz frequency (also known as the industrial-scientific-medical band, or ISM). Bluetooth allows any device containing Bluetooth-standard chips to communicate and share information. The technology supports both point-to-point and point-to-multipoint connections, enabling up to seven slave devices to exchange data with a "master" device.

"Bluetooth was made for situations in which you need to push information down automatically or send up information automatically in a small, contained space," said Ron Sperano, program manager of Mobile Market Development for IBM Personal Systems Group. "It will be low cost, it is low power, and it has a limited range, contributing to its security."

Despite the potential to bring wireless "to the masses," Bluetooth is still very much in its infancy. Bluetooth specification 1.0 has been released by the Bluetooth Special Interest Group (SIG), which boasts more than 2100 members to date. The SIG founding member list reads like a who's who of big guns: Ericsson, Intel, IBM, Nokia, and Toshiba. In December 1999, Microsoft, 3Com, Lucent, and Motorola signed on as well, becoming part of the SIG promoter group, which provides direction for the development of Bluetooth.

"Bluetooth is not about one product but about creating an industry standard, which requires a lot of companies," said Simon Ellis, Intel's communications marketing manager for Bluetooth and chair of Bluetooth SIG marketing. "We track our progress by comparing Bluetooth to previous industry standards like USB (universal service bus) in the PC industry. Bluetooth is like wireless USB, a method to easily connect devices without wires."

Although the groundswell of industry support seemingly guarantees market success for Bluetooth, like all new concepts, the standard faces its own set of market challenges, not the least of which is price. Add on concerns about interference and competition from other wireless technologies, and Bluetooth manufacturers have their work cut out to gain a foothold in this increasingly crowded marketplace.

"Bluetooth was supposed to be out last year, but the chip sets were late," said Gilbert Held, author of Data over Wireless and more than 40 other books on networking. "It's the chicken versus the egg syndrome: Manufacturers are reluctant to put chips in products because the chips increase the cost, so there are not a lot of Bluetooth-enabled products. Someone will make it in the mass markets, but who that vendor is going to be is up in the air."

In fact, chips represent the heart of any Bluetooth device, and their cost is critical in making Bluetooth a mass-market industry. Industry sources agree that for Bluetooth to become ubiquitous, chips must be priced at less than $10 each, preferably lower than $5. IBM and Toshiba, for example, announced Bluetooth-enabled PC cards last year-at a retail price of around $150 per card. While the price will eventually drop as the cards become more popular and the chips become cheaper, Ellis believes it will be another two to three years before radio chips can be embedded directly into devices at a reasonable price, eliminating the need for separate Bluetooth-enabled cards.

"There are supposed to be one billion Bluetooth-enabled devices by the year 2005," said Sperano. "This year we will see the intro of many more devices-cell phones in the first half of the year, laptops and PDAs in the second half. Next year there will be even more devices, and by 2003, it will cost $3 to $5 per chip set."

Bluetooth will initially be used to replace cable connections and to create personal area networks, according to Sperano. The next phase will see integration of Bluetooth into devices, which will drive down the price of chips (and corresponding Bluetooth devices) to mass-market levels. Rolf Nissen, system marketing manager for Philips Semiconductors, believes chip prices will drop even more quickly, however.

"We've all had the magic $5 figure in mind," Nissen said. "All manufacturers are facing the same task, nothing has hit mass production capability. Bluetooth has made major steps over the last two years, a very short time period. Our customers have compressed the design into something usable."

From a marketing point of view, Nissen believes Bluetooth is in the middle of the "effectiveness wave"-in other words, the number and variety of Bluetooth-enabled products is steadily increasing. The next wave, the demand wave, should come by year's end.

"After we've decreased cable dependence, demand for Bluetooth everywhere will set in," he said. "Everything will be connected. Your refrigerator will be able to send a list of items to be purchased to the network access point, which will communicate with the delivery company, and groceries will be ordered and delivered automatically."

Interference and other potential roadblocks

Despite all this activity in both the consumer and business markets, concerns about potential interference between wireless devices continue to be an issue, especially for hospitals and healthcare providers. Competition for the airwaves is intensifying due to the popularity of the 2.4 GHz band and wireless devices in general, with the Home RF standard emerging for the home-based wireless market. Bluetooth products have to exhibit high reliability and coexist with legacy and next-generation wireless technologies, especially if the standard is to make headway in the healthcare segment. The well-known prohibition against cell phones in hospitals has set a precedent against uninhibited use of wireless devices in medical settings.

"On the surface, Bluetooth could be great for wireless devices in the healthcare market," said Josh Fisher, W.R. Hambrecht senior analyst for healthcare. "It isn't clear how well Bluetooth devices will work, especially in hospitals with other wireless devices and radio waves present. There could be interference from lead walls and MRI machines."

Because the 2.4 GHz band is unregulated, it is getting crowded out there, being used by Bluetooth, IEEE 802.11b, and even microwave ovens. Some providers see potential in shifting the IEEE 802.11 wireless over into the 5 GHz range, freeing up the ISM band for use by lower throughput technologies such as Bluetooth. The second ISM band is set at 5.8 GHz.

"The FCC has set up a group to examine interference issues," said Jerome Pesant, innovation manager with Ericsson Canada and Ericsson's Bluetooth ambassador. "In two to three years, what we can see is that wireless data collision problems can be solved by having some technologies move into the 5 GHz band."

The SIG has a working group that is cooperating with a similar working group in the IEEE organization, according to Intel's Ellis. The groups are dealing with interference issues among the different wireless technologies, and Ellis doesn't rule out the possibility of the standards themselves adapting to the changing wireless landscape.

"There are two sides to the story with interference," Ellis said. "The first is the way that frequency is allocated; regulatory agencies play a big role. The second is that the technology itself must be robust, because we don't want data loss due to interference. We may modify the Bluetooth specification if a real need emerges."

Solutions to interference issues are complicated in part by the footrace between the various emerging wireless standards. While IEEE 802.11b and Bluetooth operate in the same 2.4 GHz range, each operates slightly differently and seeks to satisfy a different need involving the transmission of data.

"We think there are three key environments," Ellis said. "The first is the personal area-within a room, an office, a car-served by Bluetooth. The second is the wireless LAN environment involving computer technologies alone-served by the 802 technologies. The last is wide area-currently used primarily for voice-served by cell phone technologies."

In terms of wireless protocols, Bluetooth's primary competition will most likely come from Home RF for low-cost home networking. And then there is IrDA (infrared transmission), which already comes installed as a standard feature on laptops. But Held doesn't see these two contenders pushing out Bluetooth.

"Home RF is for lower cost networking in the home environment and operates in the 900 MHz band," he said. "It has published standards, but I'm not aware of anyone making chips for it."

Making it in medical

With all the hoopla and caveats in mind, however, Bluetooth proponents agree that it will be a while before the technology really bears fruit in healthcare. Even so, consensus is that the technology will work its way into the medical segment sooner rather than later.

"Pieces of the technology are already available that could enter the healthcare market, and as soon as PDAs become Bluetooth-enabled, Bluetooth could enter healthcare as early as this year," Sperano said.

However, the medical industry's (in)famous thrift and conservatism could impede Bluetooth's spread into the clinical environment. While certain medical device manufacturers have expressed interest in Bluetooth, the SIG has not yet formed a working group for a Bluetooth medical specification, according to Ellis.

"Medical is one of the vertical segments that looks for low cost and high availability," he said. "Today Bluetooth is a basic technology. There are features that medical equipment can use-Internet access, connection between devices, a common language for synchronizing information. But it will probably take five years before Bluetooth becomes widespread in healthcare."

At least one mobile healthcare player isn't waiting. PatientKeeper (formerly VirtMed, see related story on page 2) is demoing what it claims is the first commercially available Bluetooth product for healthcare in the U.S. at the HIMSS conference in New Orleans.

"Bluetooth is interesting to us for multiple reasons," said Stephen Hau, vice president of platform development for PatientKeeper. "The fact that it will provide more interoperability between systems, both mobile and electronic devices, is extremely attractive. We have incorporated Bluetooth into our platform so that our customers and developers who want to use Bluetooth can."

The firm has combined Bluetooth technology with its PatientKeeper Mobilizer server. Bluetooth access points within a medical facility, working in conjunction with Mobilizer middleware, enable communication between a clinician's Bluetooth device and a facility's systems, allowing the clinician to pull lab reports, patient records, and other data stored there. The product is commercially available, and current PatientKeeper Mobilizer customers can become Bluetooth-capable through a simple hardware upgrade.

"We believe in a strong future for Bluetooth," Hau said. "We want to support that right now. Coming down the pike, there will be Bluetooth-enabled printers, cell phones, and other devices. This year more Bluetooth hardware will be rolled out, and our platform will work all of it."

PatientKeeper has not experienced any interference problems while testing the product. Because of their low power use, Bluetooth transmitters have a safer frequency range.

"Interference is becoming less and less of an issue," Hau said. "Hospital CIOs are becoming more and more comfortable with wireless in general. And PDAs have proved to be the exception to slow adoption in the physician community."

Internationally, Sweden appears to be at the forefront of Bluetooth development for medical devices. Two Swedish firms, BlueLabs and Biosys, are using Bluetooth to transmit vital signs and other medical information from sensors installed in a chair to a nearby computer for processing (HNN 9/20/00). Another Swedish company, Ortivus, is working with Bluetooth to connect sensors to an electronic cardiac monitoring system.