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Hospitals Press FCC to Expand Health Care on the Airwaves
The Federal Communications Commission (FCC) is undertaking a review of its spectrum policies to determine how it can support expanded telehealth wireless applications.1 Hospitals are pushing the FCC hard to do so for a number of reasons. Added wireless capacity would expand connectivity for small rural health facilities and give them access to specialists in big cities, helping to keep health care costs low for patients and to improve care. But the bigger prize is opening up the world of in-home health monitoring as fifth-generation (5G) service enables the so-called “Internet of things” (IoT)—an ever-evolving term the Oxford Living Dictionary defines as “the interconnection via the Internet of computing devices embedded in everyday objects, enabling them to send and receive data.”2 A third imperative is to add spectrum to prevent interference with inpatient monitoring of wireless medical devices because of the multitude of devices using the 1.4-GHz band available for wireless medical telemetry service (WMTS).
WMTS allows many patients to be monitored from a central location, improving efficiency and, at the same time, increasing the ability of health care workers to respond quickly to physiological events and capture physiological information, according to the American Society for Health Care Engineering. “With an increasing number of wireless medical telemetry devices being utilized at Steward’s hospitals, we are beginning to see signs of spectrum congestion and interference between these monitoring devices,” says John Polanowicz, Executive Vice President of Network, Insurance, and Physician Operations for Steward Health Care, a large community health network serving New England.
A company called TerreStar Corporation applied to the FCC in 2016 for an exemption allowing it additional time to build out its 1.4-GHz network, which would add five additional megahertz of spectrum for WMTS, an almost 67% capacity increase. The FCC has not issued that exemption yet and ostensibly is looking for feedback from interested parties as part of the request for comments it issued in May, in which the TerreStar exemption request was just one of a number of health care telemetry issues.3 The TerreStar expansion of the medical telemetry spectrum would allow hospitals, for example, to monitor patients en route in ambulances or after discharge.
Hospitals want more than increased spectrum, however; they want more FCC funding from the FCC’s Rural Health Care (RHC) program to expand medical telemetry into rural areas. That program includes the Telecommunications and Healthcare Connect Fund programs, which provide a total of $400 million per year for broadband hookups for eligible, mostly rural, applications.4 That annual budget was set in 1997. Geisinger Health, for example, brought three top executives to Washington in June to meet with FCC officials. The Geisinger contingent asked the FCC to up the RHC program to $800 million per year. The FCC would have to make that decision. The RHC program is one of four supported by the universal service fees telecommunications providers pay the FCC, fees the companies pass on to consumers. Theoretically, the FCC could take money from one of the other three programs and give it to the rural health program, or it could increase the fees that providers pay into the universal service fund.
Geisinger received $3 million from the Healthcare Connect Fund in 2016 and will be spending that money over three years. So far, according to Mary Honicker, Program Director for Information Technology and External Customer Relations at Geisinger, the health system has installed broadband circuits and equipment in 95 rural health facilities, some of them not even connected to Geisinger. Those broadband circuits, for example, allow emergency room generalists at those small rural hospitals to teleconnect with specialists at bigger hospitals (again not just Geisinger hospitals, of which there are four in Pennsylvania) and keep those patients in their local communities. That helps the rural hospitals keep their beds full and stay afloat, keeps cost of care for patients lower than it would be if the patient had to be transferred to a “big-city” hospital, and allows a patient’s family to stay in close contact.
Connecting very rural electronic intensive care units also improves care, says Joseph B. Fisne, Associate Chief Information Officer at Geisinger. “If you’re having a stroke, there may be a limited amount of time to treat it. A small hospital emergency room may not have access to a staff neurologist who is in the hospital or even nearby. If that hospital can get a neurology consult via teleconferencing, you may be able to diminish the severe effects of that stroke.”
Fisne explains that the arrival of 5G service in a few years will enable the IoT. In that environment, there will be health care applications in areas such as medication management where seniors have access to pill-dispensing machines that are electronically connected to pharmacies or even family members who are able to monitor both the taking of pills and the need for refills.
Darrell West, Vice President and Director of Governance Studies and Founding Director of the Center for Technology Innovation at the Brookings Institution, explains, “The FCC needs to free up spectrum for 5G applications. That involves repurposing space from existing organizations that are underutilizing the spectrum, such as defense agencies and television broadcasters. Plus there are new technologies that make more efficient use of existing spectrum that can free up space for 5G products.”
In a proposed rule in August 2016, the FCC asked for comments on spectrum expansion for mobile uses, including performance requirements for innovative uses such as IoT and machine-to-machine communications.5
But taking spectrum from one group of users and giving it to another is always a political challenge, and it won’t be any less so because health care providers want a bigger share of the airwaves.
- Federal Communications Commission. FCC seeks comment on accelerating availability of broadband health technologies July 21, 2017; Available at: www.fcc.gov/health/public-notice. Accessed July 27, 2017
- Oxford Dictionaries. Internet of things Available at: https://en.oxforddictionaries.com/definition/Internet_of_things. Accessed July 27, 2017
- Federal Communications Commission. FCC seeks comment on accelerating broadband health tech availability April 24, 2017; Available at: www.fcc.gov/document/fcc-seeks-comment-accelerating-broadband-health-tech-availability. Accessed July 27, 2017
- Federal Communications Commission. Rural Health Care Program July 20, 2017; Available at: www.fcc.gov/general/rural-health-care-program. Accessed July 27, 2017
- Federal Communications Commission. Use of spectrum bands above 24 GHz for mobile radio services. Fed Regist 2016;81;(164):58270–58308. Available at: www.gpo.gov/fdsys/pkg/FR-2016-08-24/pdf/2016-19793.pdf. Accessed July 27, 2017