Parties Offer Advice for FCC Action in Broadband Health Care Initiative

May 25, 2071–Parties are calling for the FCC to take a number of actions as part of its Connect2Health initiative, including making more spectrum available for broadband services, streamlining infrastructure deployment, and modernizing its Rural Health Care Program. The comments were filed in response to a 25-page public notice released in April that solicited views on ways in which the FCC can further the seven objectives of the initiative, as well as on the source of authority for FCC action in these areas (TR Daily April 24). FCC Chairman Ajit Pai announced in March that the Connect2HealthFCC Task Force, which was established by former Chairman Tom Wheeler in 2014, would continue its work during his chairmanship, and that Commissioner Mignon L. Clyburn would continue to lead the effort (TR Daily, March 16).

The objectives outlined in the April 24 public notice are “promoting effective policy and regulatory solutions that encourage broadband adoption and promote health IT”; “identifying regulatory barriers (and incentives) to the deployment of radio frequency (RF)-enabled advanced health care technologies and devices”; “strengthening the nation’s telehealth infrastructure through the FCC’s Rural Health Care Program and other initiatives”; “raising consumer awareness about the value proposition of broadband in the health care sector and its potential for addressing health care disparities”; “enabling the development of broadband-enabled health technologies that are designed to be fully accessible to people with disabilities”; “highlighting effective telehealth projects, broadband-enabled health technologies, and mHealth applications across the country and abroad—to identify lessons learned, best practices, and regulatory challenges”; and “engaging a diverse array of traditional and non-traditional stakeholders to identify emerging issues and opportunities in the broadband health space.”

In its comments in GN docket 16-46, CTIA said that “the Commission should implement policies that will support adoption and deployment of mobile health solutions.”

The trade group called on the FCC to (1) “[a]void application of outdated Title II regulations to mobile broadband services, which threaten advancements that could unlock future opportunities for the health care sector;” (2) “[a]dopt modernized infrastructure policies that will streamline deployment processes so that wireless providers can deploy broadband rapidly and efficiently across the country;” (3) “[m]ake available licensed, exclusive-use spectrum in low-, mid-, and high-band frequencies, which are necessary to support next-generation networks;” and (4) “[e]nsure that the Commission’s Universal Service rules permit the deployment of wireless networks.

“By taking these steps, the Commission can foster a regulatory environment that promotes the development of additional mobile health innovations for the benefit of all consumers,” CTIA added.

The Competitive Carriers Association urged the Commission and Congress to promote broadband services as the key to better health services. The group said the FCC should (1) adopt policies making more spectrum available, including in the spectrum frontiers proceeding; (2) promote network deployment; (3) make available target universal service funding; and (4) guard against industry consolidation.

Gains in telemedicine “will be realized in rural areas where they are needed the most only if sufficient broadband networks are built and maintained,”  NTCA said. “The full benefits of telemedicine must be envisioned beyond monitoring of vital statistics to encompass the full range of consultations and physician/patient interactions. NTCA has demonstrated its commitment to these principles and the actions of its members demonstrate the commitment and ingenuity of rural broadband providers in these regards.”

“The Commission can advance the interests of consumers by working with industry to ensure a sufficient supply of spectrum, taking action to streamline any governmental involvement in infrastructure development, and supporting industry efforts to develop user-friendly, private, and secure interactions between users and technologies,” said the Consumer Technology Association. “Further, CTA’s members are successfully operating within the existing FCC regulatory framework, recently bolstered by the implementation of the Twenty-First Century Communications and Video Accessibility Act (‘CVAA’), to make health and wellness solutions accessible to and usable by individuals with disabilities.”

“In the Notice, the Commission recognizes the significant potential that broadband-powered technologies have for improving healthcare outcomes, and raises a number of important issues regarding the barriers that persist to the widespread adoption of such technologies,” Comcast Corp. said. “Foremost, the Commission should continue its efforts, highlighted by the Chairman’s Digital Empowerment Agenda, to ensure that all Americans have access to high-speed broadband services. In addition, our experience suggests that there are impediments that may lie outside the Commission’s purview – including state licensing, Medicaid reimbursement, and medical device regulation – for which regulatory clarity could be helpful to innovators in this space. The Commission’s continued focus on these issues will help ensure that all providers and patients can benefit from the innovations and improved solutions made possible by broadband.”

Nokia said it “believes the Commission can play a key role in this effort by enabling collaboration between technology providers, health organizations, financial institutions, and other government stakeholders. In line with this approach, the Broadband Commission Working Group on Digital Health, chaired by Nokia and the Novartis Foundation, convened leading digital health experts from governments, international and non-governmental organizations, academic institutions and the private sector for the purpose of producing a report: Digital Health: A Call for Government Leadership and Cooperation between ICT and Health (Attachment 2).”

Among other things, Nokia said the report said that “[e]ffective governance mechanisms that engage stakeholders, who have clearly defined roles, can help to ensure efficient decision-making for a national digital health strategy.” In addition, “A national ICT framework that facilitates alignment between health and ICT sectors can promote connectivity and interoperability, establish common standards, and enable appropriate policies and regulations in digital health,” Nokia said, citing the report.

“First and foremost, Qualcomm respectfully requests that the FCC make available for commercial use without delay the spectrum bands it has allocated for mobile use. This includes the millimeter wave spectrum the agency authorized for mobile operations in the July 2016 Spectrum Frontiers Report & Order,” Qualcomm, Inc., said. “This high-band spectrum will work in tandem with low-band and mid-band spectrum to support 5G-based mHealth applications and services to underserved areas. Commission action to open additional low-, mid-, and high-band spectrum for exclusive, licensed use also is needed to support mHealth needs in the coming years. Second, Qualcomm supports the FCC’s active efforts through its universal service programs to encourage deployment to unserved and underserved areas. Third, we support the agency’s actions to streamline approval processes for wireless infrastructure. Modernizing siting approval processes for miniature cell site installations is needed to enable the efficient deployment of infrastructure necessary to support 4G LTE Advanced and soon-to-be deployed 5G networks.”

GE Healthcare said that “the FCC can encourage advanced healthcare solutions by ensuring that licensed Wireless Medical Telemetry Service (‘WMTS’) systems operating on television channel 37 (‘Channel 37’) are protected from harmful interference and that a sufficient amount of spectrum exists to meet the nation’s growing demand for safety-of-life wireless medical telemetry operations. To protect these safety-of-life systems from harmful interference, the FCC should revise the Channel 37 WMTS separation distances devised in its 2015 Part 15 R&O and address concerns about the dependability of white space device and database software. To ensure that sufficient spectrum is available, the FCC should grant TerreStar’s pending waiver request regarding certain of its 1.4 GHz licenses and consider auctioning spectrum in the 1.3 GHz band for commercial use. In addition, the FCC can encourage the development of other advanced healthcare solutions, such as those that rely on 5G networks and applications, by addressing concerns about interoperability and other potential barriers to network deployment.”

“By enabling TerreStar to deploy wireless medical telemetry systems in its licensed 1.4 GHz spectrum, the Commission can protect and promote life-critical medical telemetry transmissions and enhance patient experiences and outcomes at health care facilities throughout the United States,” Terrestar Corp. said.

“Given the extraordinary advancements in the telehealth space, the Commission must maintain its focus on building 5G networks while closing the digital divide,” said the Connected Health Initiative of ACT, which represents apps developers. “CHI is encouraged by Chairman Pai’s recent action to make 5G deployment a priority for the Commission. Additionally, we applaud the Chairman’s efforts to close the digital divide by establishing his ‘Gigabit Opportunity Zone’ program as articulated in his digital empowerment agenda, which would ‘bring broadband and digital opportunity to our nation’s most economically challenged areas.’ CHI urges the Commission to continue on this trajectory to ensure that the necessary infrastructure is in place to facilitate more innovative healthcare solutions in this country. CHI also encourages the Commission to coordinate with other key agencies in the connected health space, such as the Department of Health and Human Services.”

The Schools, Health & Libraries Broadband Coalition said the FCC should (1) “[i]ssue a Notice of Proposed Rulemaking (NPRM) to modernize the RHC program, as requested by the SHLB Petition filed in 2015”; (2) “[u]se that NPRM to embark on a data gathering proceeding to determine the number of eligible health care entities and estimate the cost of upgrading their level of broadband connectivity”; (3) “[a]dopt a rule similar to the roll-over rule in the E-rate program to allow funds that are committed but not disbursed to be used to cover future applications”; (4) “[m]ake the rates charged to Health Care Providers more transparent and publicly available to facilitate benchmarking”; (5) “[c]onsider increasing the RHC support for rural HCPs to 855 to improve the flow of dollars to rural HCPs”; (6) “[i]mprove the processing of consortia applications”; (7) “[c]onsider eliminating the cap on the Telecommunications Program to be consistent with the mandate in the statutory language”; (8) “[s]ignificantly raise the cap for the Healthcare Connect Fund to promote greater investment in rural markets and otherwise ensure that the entire RHC program provides a predictable amount of universal service support”; and (9) “[p]romote network sharing by explicitly allowing health networks and networks funded by E-rate, Connect America Fund and other programs to be used by health care providers to lower the costs for all programs.”

Among other things, the American Telemedicine Association said that the FCC should take several actions “[t]o maximize the value of telehealth …” It said the Commission should (1) “[e]xtend the availability, capacity, and quality of broadband infrastructure, to the maximum extent economically feasible”; (2) “[e]ncourage a nationwide grid with Federal support of network bridging between and among the hundreds of telemedicine networks in the U.S. to expand the reach of healthcare services and improve care management”; (3) “[f]oster the development and deployment of 5G wireless connectivity”; (4) “[u]pdate the Rural Health Program so that all rural Medicare and Medicaid telehealth sites are eligible for discounted rates”; and (5) “[u]se the Lifeline program for essential communications services, including broadband.”

The American Hospital Association said it “appreciates the Commission’s dedication to improving the administration of the RHC Program to meet the broadband connectivity needs of rural health care providers. With modest changes to the HCF [Healthcare Connect Fund], the FCC can incent greater participation and further expansion of broadband, closing this aspect of the digital divide, and improving the lives of rural Americans.”

“Rural America’s health providers face significant barriers in access to a robust broadband network.  Lack of clear financial incentives and access to capital, coupled with long distances between sites, contributes to a system in which rural providers are in danger of being left behind in the digital divide.  In contrast, the benefits of broadband and a fully integrated health information technology system have the potential to address many of rural America’s current health care hurdles,” said the National Rural Health Association. “While many positive steps have been taken by the federal government to expand broadband access to rural America, there is still a great deal of work to be done. NRHA believes there are some hurdles within the current framework that can be eliminated in order to achieve our shared objectives. We urge increased efforts to foster interagency collaborations. While we applaud the use of the specialized expertise of the various federal agencies, we believe that this approach has led to silos of information and programs that compete rather than complement other programs with similar aims. Instead, a lead agency should coordinate among the various involved federal agencies to avoid duplication of efforts and to eliminate unnecessary and often confusing different program requirements from different agency partners.”

The National Organization of State Offices of Rural Health said it “believes that the FCC can help reduce the broadband gap faced by health care providers in rural/frontier communities.” It said the FCC should, among other things, (1) “give the highest preference/priority in FCC programs to rural/frontier health care providers in locations with the lowest broadband capacity”; (2) “give additional preference/priority in FCC programs to health safety net providers in rural/frontier communities”; and (3) “assure that financial support for rural/frontier health safety net providers is maximized and that any financial support for health care providers in urban locations in non-underserved areas does not reduce program capacity to meet priority needs in rural/frontier areas.”

The filing added, “NOSORH also believes that it is important to have a clear picture of the extent of affordable broadband availability to health care providers in rural/frontier communities. NOSORH further recommends that the FCC conduct a survey of health care providers in these communities. This effort could be conducted fairly rapidly with the help of national and state level health provider partners including NOSORH, the National Association of Rural Health Clinics, the National Association of Community Health Centers, the National Rural Health Association and the American Hospital Association. The results such a survey would help inform FCC decisions to accelerate the adoption and accessibility of broadband-enabled health care solutions in rural/frontier communities.”

The Idaho Primary Care Association said the RHC needs to be modernized and reformed. “Undertake a modernization program that could include components of the E-rate program that include inflation proofing and authorization to allocate carry-over funds to future years,” it said. “RHC reform – Consider changes to the program that could designate some funds for frontier communities for whom access to dedicated internet service is extremely expensive and difficult.”

“We ask the Commission and the Connect2Health Taskforce to consider Indian Country when addressing rural health and moving forward with this notice,” said the National Congress of American Indians and the National Indian Health Board. They said that in order to do this, the FCC should (1) enter into a memorandum of understanding with the Indian Health Service, (2) create a tribal set-aside of at least 5% for all health care-related funding, and (3) establish a Telehealth Working Group to focus on the needs of Indian country.

“We ask that you urge the FCC to increase the rural health care universal  service support budget, index it for inflation, and provide for any unused funds to be carried forward to future funding years. This will ensure Alaska’s rural and Bush communities continue to have access to affordable broadband telehealth services, critical for improving access to care,” said the Alaska Tribal Administrators Association.

The National Public Safety Telecommunications Council said it “encourages the Commission and the task force to include EMS as a stakeholder in this important proceeding. While not specifically mentioned in the Public Notice, EMS is an essential element of the healthcare ecosystem. EMS serves as an essential first response to those injured in accidents, having a heart attack or stroke or experiencing other sudden health problems. EMS often serves as an integral life-saving link with a hospital during patient care in the field and then during transport to an emergency department. It is also improving community access to affordable healthcare through community paramedicine.”- Paul Kirby,

Courtesy TRDaily