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Federal Communications Commission



Communications Technology and Healthcare

September 28th, 2010 by Admin User

Good morning. It’s a pleasure to be with you this morning.

Thank you, Stuart Ferguson, for that warm introduction.

Thank you also to Jon Linkous for the invitation to join you today. Jon has been a powerful advocate for the benefits that telemedicine can bring to patients, doctors and medical professionals and we’re always eager to hear what he has to say.

And thank you to Kerry McDermott on my team who is here with me today. Kerry, please stand. Kerry led the process of crafting the National Broadband Plan recommendations relating to wireless medical devices that are at the core of the future of telemedicine, and she did an outstanding job.

Introduction:  Telephones

Over a century ago, Alexander Graham Bell met with the President of the United States, Rutherford B. Hayes, to demonstrate a new invention: the telephone. After Bell finished his demonstration, the President turned to him and said, “That’s an amazing invention, but who would ever want to use one of them?”

As it turned out, the answer to the President’s question was simple: doctors.

As the eminent sociologist Dr. Paul Starr notes, the first recorded telephone exchange connected 21 Connecticut doctors with the Capital Avenue Drugstore in Hartford. The first phone line in Rochester, Minnesota, connected a doctor by the name of Mayo with his local drugstore. By 1923, use of the telephone was so widespread in the medical profession that a Philadelphia doctor’s manual on medical practice remarked that it had become as necessary to the physician as the stethoscope.

Our era is perhaps an even more transformative time for medicine. As all of you know firsthand, we’ve seen tremendous innovation and investment in telemedicine over the last decade.

What We’ve Learned

Last fall, the FCC hosted a workshop and a field event on the intersection of broadband and health care in the lead-up to producing the National Broadband Plan’s health care recommendations.  In those sessions, practitioners told us amazing success stories in telemedicine, and patients reminded us how powerful a tool broadband is for improving health care in America.

Leaders from the University of Kansas told us about how their TeleKidcare® program helped save the life of a 4th grade girl with pneumonia. The young girl was running a fever at home and her mother walked to school to report that her daughter would be absent that day. The school nurse convinced the mother to bring her daughter to the school so that she could be seen by a doctor at the University of Kansas Medical Center via the school’s broadband video link. The mother brought the girl to the school later that day. In the middle of the exam, the doctor instructed the school nurse and mother to get the girl to the hospital immediately. There, the girl was treated for life-threatening pneumonia, which would have otherwise gone undiagnosed. Thankfully, she made a full recovery. Without telemedicine, this would not have been possible.

Leaders from Avera Health, a non-profit health care delivery network operating in South Dakota, Minnesota, Iowa, and Nebraska, told us about a baby born two months premature during an ice storm. The nearest tertiary care center was 80 miles away. Using telemedicine, staff caring for the baby connected to neonatologists who were able to provide them with specific actions to take to stabilize the baby, who is now healthy and developing normally.

Leaders from CHRISTUS St. Catherine Hospital in Katy, Texas, told us about their comprehensive stroke center program that incorporates telemedicine from the time EMTs arrive on the scene to the time the patient is receiving care in the hospital emergency department.

These are just a few compelling examples that illustrate how telemedicine can be a powerful means for improving health care and the quality of life for all Americans.

Gaps

However, we’re a long way from ubiquitous telemedicine today. When developing the National Broadband Plan, we realized that to maximize broadband availability and use, the United States not only needs bigger and faster networks, but it also needs innovation and investment throughout what we called the “broadband ecosystem” – the networks, the applications, and the devices that affect what Americans can do with broadband.

More capable networks enable medical facilities to employ devices that run applications like electronic health records and image transfer applications. And more advanced applications can often mean saving more lives.

But today, America has gaps in all three parts of the broadband ecosystem that are slowing progress through this “virtuous circle” of innovation, and preventing telemedicine from being adopted more widely.

Connectivity via robust networks is a baseline requirement for telemedicine. But 3,600 small providers in the United States lack the connectivity they need to adopt even basic health IT, let alone high-definition video consultation. For example, nearly 30 percent of federally-funded Rural Health Clinics and a third of Indian Health Service locations do not have basic broadband connectivity.

Furthermore, although Americans send over 4 billion text messages on a typical day, our 9-1-1 system still lacks the network deployment and equipment to support the transmission of text and images to emergency response centers. The U.S. still has only one 9-1-1 call center, in Black Hawk County, Iowa, that can accept text messages. If we are to take full advantage of the possibilities of telemedicine in emergencies – say, sending images of a broken jaw to emergency responders so they can know what to expect when they arrive at the scene of an accident – there is much more work to do.

Numerous health IT solutions, specifically telemedicine solutions, promise to improve care and quality of life, and reduce costs. The potential of electronic health records, video consultations, diagnostic image transfer, remote monitoring, and wellness apps is largely untapped. We know that robust networks are needed to support the capture and exchange of growing amounts of data, and payment reform is needed to promote adoption of these solutions.

Today, a number of wireless medical devices help patients focus on wellness or manage chronic conditions. Innovation has advanced diabetes care from countless finger pricks and injections to continuous, real-time glucose monitoring devices linked to insulin pumps. Many products that help consumers manage their health have been developed, but haven’t made it to market because investors are unclear about the regulatory pathways for those products. And because few insurers reimburse for telemedicine services, practitioners are generally unable to invest in the devices that make telemedicine possible, like ECG transmitters or telepresence walls.

What We’re Doing

To close these gaps, we at the FCC have relied on the comprehensive blueprint for action laid out in the National Broadband Plan. But even more importantly, we have relied on close partnerships and constant communications with other government agencies like the Office of the National Coordinator for Health IT, FDA, CMS, the National Telecommunications and Information Administration at the Department of Commerce, and state emergency management and health departments, to ensure that we are on the right track and able to course-correct as necessary.

Let me share with you some of the most exciting things we’re doing to make ubiquitous telemedicine a reality in the United States.

First, let’s talk about networks. Although telecommunications providers may build networks in rural areas capable of meeting everyday consumer needs, rural health care facilities often require much higher levels of connectivity.

Hopefully, you’re familiar with the concept of an “anchor institution.” Anchor institutions are entities critical to the vitality and social life of a community – schools, libraries, and health centers are primary examples. It’s vitally important that rural health care providers have the infrastructure necessary to take advantage of telemedicine and the ability to pay for the connectivity that makes it possible. Health centers in remote areas of the country can benefit from telemedicine – perhaps even more than urban areas. Connecting hospitals and other health facilities should be done regardless of where they are located.

We’re very pleased to see progress on the network funding front. Last month NTIA awarded hundreds of millions of dollars to build statewide telehealth networks, including $20 million in Nevada, $70 million in Mississippi, and $102 million in Arkansas. At the FCC, we’ve made $83.5 million in funding commitments through our pilot program to help build 35 telehealth networks across the country.

We also recognize that we could do a better job with our Rural Health Care Program. So, in July we proposed rules to reform it. At the highest level, these rules suggest providing support for both the continued construction of new statewide and regional health networks and deeper discounts on the cost of monthly Internet access for rural providers. Comments from the ATA and many of you on these proposed rules are invaluable as we work to design a program that targets support efficiently, makes resources available to more entities, and removes excessive burdens on applicants. The Commission’s role is circumscribed by the Communications Act, our authorizing statute. So while we work to improve the rural health care program to achieve Congress’s goals, we recognize that the FCC is only part of the answer. As a result, of course, we will continue to work with our partners at NTIA, USDA, HHS and other federal agencies to coordinate our efforts.

We also see a lot of promise to better leverage wireless networks to advance telemedicine and spark new applications in health care. Just last week, the FCC adopted an order that will create opportunities for investment and innovation in advanced Wi-Fi technologies in unused parts of TV spectrum, known as “white spaces.” These technologies can help improve connectivity for health care providers. In fact, we issued a one-year experimental waiver for Hocking Valley Community Hospital in Ohio to deploy a community-wide wireless network for affiliated health care providers over TV white spaces. In addition to providing wireless access on and near the hospital campus, their network will enable wireless data transfer from ambulances and other first responder vehicles. We’re following this closely and hoping that they achieve improvements in care delivery and health outcomes that might be replicated elsewhere.

Speaking of first responders, last week the FCC also adopted an order requiring wireless carriers to provide more granular information about the location of 9-1-1 callers. This helps emergency medical technicians find people more quickly. We also released formal inquiries asking for feedback on how next-generation 9-1-1 can better support emergency response. This is part of our efforts to make better information available to EMTs and other first responders – who are key players in health care delivery at the most critical moments.

Second, applications. We’re working to make new applications possible, especially when it comes to telemedicine. We hope that our actions to reform broadband support mechanisms enable more providers to take advantage of electronic health records, video conferencing, image transfer and remote monitoring technologies. We hope that our actions to open up TV white spaces unleash innovation in wireless health care applications.

We also hope that our work with the FDA to maintain a flexible regulatory environment for mobile health devices will spark new health applications for prevention, detection, treatment and management of conditions that will soon be available to patients.

Finally, devices. We’re working with our federal government partners to craft consistent, smart spectrum policy that will promote innovation in devices. As ATA and the folks in this room demonstrate everyday, the combination of wireless and medical technologies opens up vast new opportunities for improving health care.

At a July event with our Chairman, Julius Genachowski, and FDA Commissioner Margaret Hamburg, the FCC and FDA launched an initiative to clarify the requirements and improve the efficiency of the approval process for converged communications and health care devices. Through a legal document called a Memorandum of Understanding, we were able to improve information exchange between our agencies and streamline collaboration. We expect this will help us unleash the benefits of broadband for health care.

We also released a joint statement of principles on wireless health that will guide our work as we tackle this important topic. To briefly summarize the key principles, we recognize that all Americans stand to benefit from broadband-enabled wireless health solutions; we must unleash innovation while assuring patient safety; and we must partner effectively to do so.

The proliferation of innovative wireless medical devices is an exciting prospect that we at the FCC welcome. And we will continue to look for creative ways to promote wireless connectivity. This will improve remote monitoring and care delivery. We look forward to working with the telemedicine community as part of that process.

Call to Action


Going forward, the FCC will continue to be an advocate for the power of telemedicine to improve health care. And we’ll continue to share that message with our federal agency partners to promote a consistent, integrated approach to improving communication networks, applications, and devices in the United States.

We’re excited by the possibilities that telemedicine has to offer and are committed to helping overcome the challenges it faces. To drive policy changes and make informed decisions, we need to arm ourselves with more and better data – that’s where you can help. Today I want to ask for your help gathering three types of data that will help the FCC and its partners make intelligent decisions about federal support for telemedicine.

First, actual provider-level connectivity data. In the National Broadband Plan, we used the best information available to estimate the connectivity available to providers. We also suggested guidelines on minimum connectivity thresholds to support usage of various health IT solutions in different delivery settings, ranging from solo providers to rural health centers to hospitals and academic medical centers. We need to better understand what level of connectivity providers are actually purchasing, the degree of price disparities faced, and the suitability of available broadband for adopting health IT solutions, especially telemedicine applications.

Second, we want your input on effective performance measures. The National Broadband Plan recommended that to protect against waste, fraud and abuse in the Rural Health Care Program, the FCC should require participating institutions to meet outcomes-based performance criteria to qualify for USF subsidies. I think we all agree that it’s not about the technologies or methodologies. Instead, it’s about the results for individuals’ health outcomes. The less money we spend on what doesn’t work, the more will be available for what does. We want your help in thinking through sensible performance measures that balance the need to gain insight with the need to avoid undue reporting burdens.

Finally, let us know what metrics would be most useful to track in a Health Care Broadband Status Report. Supporting health IT for the long term is going to require a better understanding of its current and projected states. The National Broadband Plan’s analysis was an initial step to advance this effort, and the Plan recommends continued publication of such a status report.

Closing

The interaction of technology and medicine has come a long way since doctors and pharmacies were first connecting via telephone lines in 1879. I am confident that with your input and with our continued collaboration with you and our federal partners, we can use telemedicine to bring higher quality, more efficient, cost-effective care to more Americans in the years to come. Thank you for the opportunity to be with you here today.



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