FCC Seeks Comment and Data on Actions To Accelerate Adoption and Accessibility of Broadband-Enabled Health Care Solutions and Advanced Technologies, 21780-21788 [2017-09309]
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Federal Register / Vol. 82, No. 89 / Wednesday, May 10, 2017 / Proposed Rules
in this proceeding should familiarize
themselves with the Commission’s ex
parte rules.
121. In light of the Commission’s trust
relationship with Tribal Nations and
Native Hawaiian Organizations (NHOs),
and the Commission’s obligation to
engage in government-to-government
consultation with them, the
Commission finds that the public
interest requires a limited modification
of the ex parte rules in this proceeding.
Tribal Nations and NHOs, like other
interested parties, should file
comments, reply comments, and ex
parte presentations in the record in
order to put facts and arguments before
the Commission in a manner such that
they may be relied upon in the decisionmaking process. But the Commission
will exempt ex parte presentations
involving elected and appointed leaders
and duly appointed representatives of
federally-recognized Tribal Nations and
NHOs from the disclosure requirements
in permit-but-disclose proceedings and
the prohibitions during the Sunshine
Agenda period. Specifically,
presentations from elected and
appointed leaders or duly appointed
representatives of federally-recognized
Tribal Nations or NHOs to Commission
decision makers shall be exempt from
disclosure. To be clear, while the
Commission recognizes that
consultation is critically important, the
Commission emphasizes that the
Commission will rely in its decisionmaking only on those presentations that
are placed in the public record for this
proceeding.
jstallworth on DSK7TPTVN1PROD with PROPOSALS
IV. Ordering Clauses
122. Accordingly, it is ordered,
pursuant to Sections 1, 2, 4(i), 7, 201,
253, 301, 303, 309, and 332 of the
Communications Act of 1934, as
amended 47 U.S.C. 151, 152, 154(i), 157,
201, 253, 301, 303, 309, and 332,
Section 102(C) of the National
Environmental Policy Act of 1969, as
amended, 42 U.S.C. 4332(C), and
Section 106 of the National Historic
Preservation Act of 1966, as amended,
54 U.S.C. 306108, that this Notice of
Proposed Rulemaking and Notice of
Inquiry is hereby adopted.
123. It is further ordered that the
Commission’s Consumer &
Governmental Affairs Bureau, Reference
Information Center, shall send a copy of
this Notice of Proposed Rulemaking,
including the Initial Regulatory
Flexibility Analysis, to the Chief
Counsel for Advocacy of the Small
Business Administration.
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Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 2017–09431 Filed 5–9–17; 8:45 am]
BILLING CODE 6712–01–P
FEDERAL COMMUNICATIONS
COMMISSION
47 CFR 1, 15, 20, and 54
[GN Docket No. 16–46; FCC 17–46]
FCC Seeks Comment and Data on
Actions To Accelerate Adoption and
Accessibility of Broadband-Enabled
Health Care Solutions and Advanced
Technologies
Federal Communications
Commission.
ACTION: Request for comments.
AGENCY:
The Federal Communications
Commission (FCC) seeks comment, data,
and information on a variety of
regulatory, policy, and infrastructure
issues related to the emerging
broadband-enabled health and care
ecosystem. The FCC seeks to ensure that
consumers—from major cities to rural
and remote areas, Tribal lands, and
underserved regions—can access
potentially lifesaving health
technologies and services, like
telehealth and telemedicine, which are
enabled by broadband connectivity. The
anticipated record will allow the
Commission and its
Connect2HealthFCC Task Force (Task
Force) to gain a broader understanding
about the current state of broadband
health connectivity. The record will also
be used by the Task Force to make
future recommendations to the
Commission.
SUMMARY:
Submit comments on or before
May 24, 2017, and reply comments on
or before June 8, 2017.
ADDRESSES: You may submit comments,
identified by GN Docket No. 16–46, by
any of the following methods:
• Electronic Filers: Comments may be
filed electronically using the Internet by
accessing the ECFS: https://apps.fcc.gov/
ecfs/ (click the ‘‘submit a filing’’ tab).
Filers should follow the instructions
provided on the Web site for submitting
comments. For ECFS filers, in
completing the transmittal screen, filers
should include their full name, U.S.
Postal service mailing address, and the
applicable docket number: GN Docket
No. 16–46.
• Paper Filers: Parties who choose to
file by paper must file an original and
one copy of each filing. Filings can be
sent by hand or messenger delivery, by
DATES:
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commercial overnight courier, or by
first-class or overnight U.S. Postal
Service mail. All filings must be
addressed to the Commission’s
Secretary, Marlene H. Dortch, Office of
the Secretary, Federal Communications
Commission. All hand-delivered or
messenger-delivered paper filings for
the Commission’s Secretary must be
delivered to FCC Headquarters at 445
12th St. SW., Room TW–A325,
Washington, DC 20554. All hand
deliveries must be held together with
rubber bands or fasteners. Any
envelopes must be disposed of before
entering the building. The filing hours
are 8:00 a.m. to 7:00 p.m. Commercial
overnight mail (other than U.S. Postal
Service Express Mail and Priority Mail)
must be sent to 9300 East Hampton
Drive, Capitol Heights, MD 20743. U.S.
Postal Service first-class mail, Express
Mail, and Priority Mail must be
addressed to 445 12th Street SW.,
Washington, DC 20554.
Additional Filing Instruction: To the
extent feasible, parties should email a
copy of their comments to the Task
Force’s email box, at connect2health@
fcc.gov. In the email, please insert
‘‘Comments in GN Docket No. 16–46’’ in
the subject line. Copies of all filings will
be available in GN Docket No. 16–46
through ECFS and are also available for
public inspection and copying during
regular business hours at the FCC
Reference Information Center, Portals II,
445 12th St. SW., Room CY–A257,
Washington, DC 20554, telephone (202)
418–0270. Documents will be available
electronically in ASCII, Microsoft Word,
and/or Adobe Acrobat.
People with Disabilities: To request
materials in accessible formats for
people with disabilities (braille, large
print, electronic files, audio format),
send an email to fcc504@fcc.gov or call
the Consumer and Governmental Affairs
Bureau at 202–418–0530 (voice) or 202–
418–0432 (TTY). Contact the FCC to
request reasonable accommodations for
filing comments (accessible format
documents, sign language interpreters,
CART, etc.) by email at: fcc504@fcc.gov;
phone: 202–418–0530 or TTY: 202–418–
0432.
FOR FURTHER INFORMATION CONTACT: For
further information about this
Document, please contact Ben
Bartolome, Special Counsel,
Connect2HealthFCC Task Force, at (770)
935–3383, or via email at
connect2health@fcc.gov (inserting
‘‘Question re GN Docket No. 16–46’’ in
the subject line). Press inquiries should
be directed to Katie Gorscak,
Communications Director,
Connect2HealthFCC Task Force, at (202)
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418–2156, or via email at
Katie.Gorscak@fcc.gov. For additional
information about the
Connect2HealthFCC Task Force, please
visit the FCC’s broadband health hub at
https://www.fcc.gov/health.
SUPPLEMENTARY INFORMATION: This is a
summary of the Commission’s
document, FCC 17–46, in GN Docket
No. 16–46, released on April 24, 2017.
The full text of this document is
available on the Internet at the
Commission’s Web site, at https://
www.fcc.gov/document/fcc-seekscomment-accelerating-broadbandhealth-tech-availability; and it is also
accessible from the Connect2HealthFCC
Task Force’s Web page, at https://
www.fcc.gov/health/public-notice. The
full text is also available for public
inspection and copying from 8:00 a.m.
to 4:30 p.m. Eastern Time (ET) Monday
through Thursday or from 8:00 a.m. to
11:30 a.m. on Fridays in the FCC
Reference Information Center, 445 12th
Street SW., Room CY–A257,
Washington, DC 20554 (Telephone:
202–418–0270; TTY: 202–418–2555).
jstallworth on DSK7TPTVN1PROD with PROPOSALS
Overview
Broadband networks are increasingly
important to our national well-being
and everyday lives. As such, we must
maximize their availability and ensure
that all Americans can take advantage of
the variety of services that broadband
enables, including 21st century health
care. In this Document, the FCC seeks
information on how it can help enable
the adoption and accessibility of
broadband-enabled health care
solutions, especially in rural and other
underserved areas of the country. We
expect to use this information to
identify actions that the Commission
can take to promote this important goal.
Ensuring that everyone is connected
to the people, services, and information
they need to get well and stay healthy
is an important challenge facing our
nation. Technology innovations in
clinical practice and care delivery
coupled with burgeoning consumer
reliance on mHealth and health
information technology (or healthIT) are
fundamentally changing the face of
health care, and a widespread,
accessible broadband infrastructure is
critical to this ongoing shift. Indeed, the
future of modern health care appears to
be fundamentally premised on the
widespread availability and
accessibility of high-speed connectivity.
By some estimates, broadband-enabled
health information technology can help
to improve the quality of health care
and significantly lower health care costs
by hundreds of billions of dollars in the
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coming decades. However, the United
States remains behind some advanced
countries in the adoption of such
technology.
As discussed in this Document, the
Commission plays an important role in
improving the quality of health care and
enabling health care innovation through
the universal service program, spectrum
licensing, and other activities. In order
to perform these and other important
roles in the health technology space, the
Commission should continue to
evaluate the nation’s broadband health
infrastructure and to understand the
ongoing technology-based
transformation in health care delivery.
This will better assure that consumers—
from major cities to rural and remote
areas, Tribal lands, and underserved
regions—can access potentially
lifesaving health technologies and
services, like telehealth and
telemedicine. Leading this effort on
behalf of the agency is its
Connect2HealthFCC Task Force. Among
other things, the Task Force is charged
with charting the broadband future of
‘‘health and care’’ in order to ensure
that the agency stays ahead of the health
technology curve. We use the phrase
‘‘health and care’’ deliberately in this
Document to reflect and include the
broad range of participants in the
emerging broadband health ecosystem,
including providers (e.g., health
systems, community health centers,
clinicians, pharmacists, nutritionists,
allied health professionals); public
health and social service agencies and
organizations; innovators and
entrepreneurs; academic and research
facilities; state and local policymakers;
patients and their caregivers; as well as
consumers who seek support to prevent
disease and maintain optimum health.
This Document seeks comment, data,
and information on a broad range of
regulatory, policy, technical, and
infrastructure issues related to the
emerging broadband-enabled health and
care ecosystem. Commenters should
address the agency’s authority on all
issues raised in this Notice. The
comment, data, and information
requested are intended to provide the
Commission with a broader
understanding and perspective on the
current state of broadband health
technology and other related issues; and
it will also inform the Task Force’s work
and recommendations.
The Broadband Health Imperative
Broadband holds promise for enabling
health care solutions and advanced
technologies that can help to meet
America’s growing health care needs.
Health care accounts for a significant
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percentage of the U.S. gross domestic
product and health care costs are
projected to increase. Studies confirm
that the United States has a serious
health care supply problem. By some
estimates, the country could face a
shortage of up to 94,700 physicians by
2025, and the forecast is worse for rural
communities. The healthcare provider
shortfall is likely to disproportionately
affect rural and remote areas which are
already medically-underserved.
At the same time, demand for health
care services is increasing. Today, over
320 million people in the United States
could, at any time, utilize health care
services, with one person added every
12 seconds (net), yet we only have
approximately 280,000 primary care
physicians to meet the needs. By the
year 2060, the number of people living
in the United States is projected to
increase by 100 million (resulting in a
total of 425+ million people), further
exacerbating the projected physician
shortage concern. To further complicate
matters, over 100 million Americans are
dealing with chronic diseases and
conditions (e.g., heart disease, stroke,
cancer, obesity, diabetes, and arthritis);
and despite best efforts, health care
disparities persist across various
geographic regions and ethnic groups.
While many individuals struggle with
one chronic illness, older Americans
often face from two to as many as five
chronic diseases at the same time. By
2030, one out of every five Americans
(or 71 million) will be over the age of
65, and 20 million will be over the age
of 80.
While broadband is not a complete
answer, there are a growing number of
broadband-enabled solutions that can
play an important role in improving
population health; addressing health
needs beyond the hospital; expanding
access to primary, acute, preventive and
specialist care, especially for those
Americans living in rural and
underserved areas; providing more costeffective solutions; improving the
quality of care; and better engaging
consumers in their health. Put simply,
health care is being transformed by the
availability and accessibility of
broadband-enabled services and
technologies and the development of
life-saving wireless medical devices.
Indeed, we are already realizing some
of the tremendous benefits that
broadband-enabled health technologies
and innovative wireless medical devices
have to offer: Electronic Health Record
(EHR) systems can track and transmit
vast amounts of patient clinical data. Xrays, MRIs, and CAT scans can be
transmitted seamlessly to specialists at
a distant hospital. Telemedicine and
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telehealth programs and services
provide opportunities to close access to
care gaps and facilitate specialized
training. Medical providers are able to
prescribe medications electronically,
saving time and money. Surgeons are
able to perform operations miles away
from patients via robotics. Self-service
health kiosks are becoming increasingly
available at pharmacies and grocery
chains, providing additional access
points for primary care and disease
screenings. Remote patient monitoring
applications and services are reducing
hospital readmissions as well as travel
and associated expenses for patients.
Mobile devices like smartphones and
personal data assistants are transforming
the way physicians manage patient care;
they are also empowering and engaging
consumers to take a more active role in
managing their own health. Implant or
body-worn monitoring, therapeutic, and
treatment technologies include wireless
blood glucose monitors and automated
insulin pumps. ‘‘Ingestibles’’ and ‘‘smart
pills’’ (broadband-enabled digital tools
that are swallowed by the patient) use
wireless technology to monitor internal
reactions in real-time, dispense
medication, and provide other granular
health data.
Veterans, in particular, have seen
tangible benefits from telemedicine.
Most notably, critical mental health
services are now accessible via
telemedicine to those veterans living in
rural areas or abroad. In fiscal year 2014,
more than 690,000 military veterans
accessed the U.S. Department of
Veterans Administration’s (VA) health
care network using telemedicine
programs, reflecting more than 1.7
million episodes of care. The Veterans
Health Administration notes that
‘‘[telemedicine] technology is now
considered ‘mission critical’ for
effectively delivering quality healthcare
to veterans, particularly for those in
rural or underserved areas.’’
These are just some of the
opportunities that broadband-enabled
services and health-related
communications technologies and
devices offer, especially for those living
in rural and underserved areas, low
density populations, and Tribal lands;
for older Americans; persons with
disabilities; military veterans; and the
economically disadvantaged—all of
whom have traditionally faced
significant health and care challenges.
We endeavor to foster the development
and accessibility of these and other
emerging communications-based
technologies throughout the country.
The work ahead, however, can only be
successful if it combines the efforts of
all levels of government, industry,
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innovators and entrepreneurs,
academia, consumers, and the health
care community. Accordingly, we seek
broad public and private stakeholder
input and collaboration on the issues
discussed below.
Request for Comment and Data
As part of its charge, the
Connect2HealthFCC Task Force is
focused on the following objectives: (1)
Promoting effective policy and
regulatory solutions that encourage
broadband adoption and promote health
IT; (2) identifying regulatory barriers
(and incentives) to the deployment of
radio frequency (RF)-enabled advanced
health care technologies and devices; (3)
strengthening the nation’s telehealth
infrastructure through the FCC’s Rural
Health Care Program and other
initiatives; (4) raising consumer
awareness about the value proposition
of broadband in the health care sector
and its potential for addressing health
care disparities; (5) enabling the
development of broadband-enabled
health technologies that are designed to
be fully accessible to people with
disabilities; (6) 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 (7) engaging a diverse array of
traditional and non-traditional
stakeholders to identify emerging issues
and opportunities in the broadband
health space.
To continue evaluating these and
other challenges, we request that
stakeholders and other interested parties
provide comment, information, and/or
data on the issues and subject matter
described below. This Notice seeks the
most current information available that
is specifically relevant to the
intersection of broadband, advanced
technology, and health care in view of
the aforementioned Task Force
objectives. For convenience, the issues
for comment are enumerated; and we
request that parties, in their submission,
identify the enumerated issue to which
their written response pertains. We also
encourage parties to identify any other
relevant issues not covered below.
Objective I: Promote Effective Policy and
Regulatory Solutions That Encourage
Broadband Adoption and Promote
Health IT
Broadband and advanced
technologies appear increasingly critical
to the effective transformation of our
health care system. First, these
technologies enable the efficient
exchange of patient and treatment
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information by allowing providers to
access patients’ electronic health
records from on-site or hosted locations.
Second, in many cases it can remove
geography and time as barriers to care
by enabling telehealth and telemedicine
applications like video consultations
and remote patient monitoring. Third,
broadband provides a foundation for the
next generation of medical devices, as
well as other health innovation and
connected-care solutions. Finally,
broadband-enabled health IT offers real
opportunities for consumers to take
charge of their own health.
To ensure that these and other
benefits continue to accrue and expand,
it is critical that we identify and engage
in appropriate efforts to address any
current and emerging issues of concern.
In this regard, we note that there are
some broad policy measures that, if
implemented, could accelerate
broadband deployment generally, and
thereby provide greater access to
broadband-enabled health technologies,
solutions and services, especially for
those consumers living in rural and
underserved areas of the country. A
prime example is the possible
establishment of ‘‘Gigabit Opportunity
Zones.’’ In September 2016, FCC
Chairman Ajit Pai, as part of his Digital
Empowerment Agenda for accelerating
the deployment of high-speed Internet
access, called on Congress to provide
tax and other financial incentives for the
private sector to deploy gigabit
broadband services in low income
neighborhoods, which he referred to as
‘‘Gigabit Opportunity Zones.’’ More
recently, the Commission created the
Broadband Deployment Advisory
Committee (BDAC) to provide the
Commission advice on, among other
things, accelerating broadband
deployment, identifying regulatory
barriers to infrastructure investment,
and making recommendations for
reducing and/or removing regulatory
barriers. We now seek additional and
specific data regarding the pace of
deployment and adoption of broadband
for health and in health care. As
detailed below, we also invite input on
policies or initiatives that the FCC could
implement to further spur deployment
and adoption of broadband services,
especially in critical need areas at the
intersection of health and broadband
(e.g., the counties identified in the
Connect2HealthFCC Task Force’s
Priority 100 and Rural 100 lists).
1. We request suggestions regarding
ways in which the FCC, based on its
authority, can further accelerate
broadband adoption in the health care
context and promote broadband-enabled
health IT solutions, either on its own or
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working in collaboration with other
agencies, and, at the same time, ensure
that such services and technologies are
fully available and accessible to all
Americans, including those living in
rural and remote areas, low density
populations, Tribal lands, and in
underserved urban areas of our country.
We also seek comment on what
impediments to these efforts exist, and
how the FCC can address them.
2. We request information and data on
the types, impact, scale, and benefits of
broadband-enabled services and
technologies used for the delivery of
health care. How is broadband currently
being used to augment or transform
existing health care delivery? What
types of health care settings are using
broadband-enabled services and
technologies besides large medical
hospitals? What variety of medical
issues are they used for? Where are
these health care settings located? What
are some of the future plans for using
broadband-enabled health services and
technologies—not just by clinicians and
hospitals but also by other participants
in the broader health ecosystem?
3. We are also interested in learning
how health technologies and services
can take advantage of new technological
applications and emerging
communications networks. For
example, what impact will the Internet
of Things (IoT) have on broadbandenabled health technologies and
services such as telehealth and
telemedicine? To what extent will
pervasive connectivity and a fully
connected environment around
individuals (e.g., IoT) shift the point of
care delivery? How might the demands
on broadband networks evolve in this
new environment? What, if any, changes
are anticipated in existing broadbandenabled health services and
technologies—operating over current
mobile networks—when 5G (Fifth
Generation Mobile and Wireless
Networks) becomes available? To what
extent might telehealth and
telemedicine be impacted by the
availability of 5G networks? What
medical device innovations are
anticipated to be developed using 5G
networks?
4. What technical issues concerning
the variety of broadband-enabled health
care solutions and technologies are
appropriate and necessary for the FCC
to consider with respect to efforts to
accelerate broadband adoption and
promote health IT solutions? Are there
issues of concern with respect to access,
availability, interoperability, capacity,
reliability, privacy, security, and speed?
If so, please describe them. Does
consideration of any of these issues vary
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depending on the technology platform—
e.g., digital subscriber line (DSL), cable,
fiber, wireless, or satellite?
5. We seek to better understand health
care providers’ connectivity
requirements. What type of connectivity
(e.g., wired or wireless; fixed or mobile)
is necessary to support the deployment
of health IT applications today and in
the near future at the different types of
health care delivery settings (e.g.,
tertiary care centers versus primary care
physician practices, larger physician
groups, clinics, hospitals, as well as
‘‘hospital in the home’’ settings).
a. What are the minimum bandwidth
and speed requirements for the different
types of health IT applications available
today and in the near future for clinical
and non-clinical settings? We also seek
comment on bandwidth constraints
brought on by increased overall usage as
well as the impact of data intensive
medical applications. Are there future
technologies or applications on the
horizon that could be bandwidth
intensive? If so, what are they, and to
what extent could compression and
other technologies provide a solution for
such future technologies or
applications?
b. Some evidence suggests that realtime image manipulation and video
(e.g., telestroke and tele-emergency
applications) will stimulate demand for
more and better broadband and at lower
prices. Are there current issues
concerning network speeds and delays
for these types of services? Do mobile
health applications present unique
considerations in terms of coverage,
reliability, and security? We seek
suggestions on whether, and if so, how
the Commission could address these
issues.
c. To what extent do rural
communities and Tribal lands have
access to Internet connection speeds
that are sufficient to support the
effective and efficient transmission of
data and video to provide telehealth,
telemedicine, and other broadband
health technology services?
d. What, if any, interoperability,
capacity, reliability, security, and speed
issues currently exist for wireless (i.e.,
radiofrequency (RF)-based) medical
devices used by patients in both clinical
and non-clinical settings (e.g., at home);
and for healthcare providers with
respect to the provision of broadbandenabled health technologies, like
telehealth and telemedicine services?
Are there other technical issues
appropriate for the Commission to
consider?
e. What impediments, if any, exist in
trying to retrofit existing and future
health care facilities (e.g., hospitals and
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clinics) for broadband-enabled services
and technologies, given current
connectivity needs and the existence of
varied spectrum environments? Do
current designs take into consideration
any potential interference concerns with
projected wireless networks and devices
that will be used in these facilities? Are
there (or should there be) industry
standards or best practices for ensuring
that new health care facilities consider
broadband in their design and account
for any necessary conduits, wiring,
building configuration, and materials
(e.g., there may be a need to consider
certain materials for internal or external
walls to better enable wireless
broadband within a facility or to limit
RF into a building) at the design and
construction phase?
6. We seek to understand the full
range of issues that might be affecting
the development and adoption of
broadband-enabled technology and
services in health care. What nontechnical impediments or issues
currently exist in the provision of
broadband-enabled health technology
services? Are there any circumstances or
practical considerations (e.g., cost,
funding, and training) that may be
creating disincentives for clinicians and
health care settings to offer broadbandenabled health services and
technologies, such as telehealth and
telemedicine? If so, please describe
what they are, including the extent and
nature of the Commission’s authority to
address them.
7. What efforts are being made at the
state and local levels to address
broadband health technology
accessibility issues in rural and remote
areas, Tribal lands, and underserved
urban areas? We seek specific
information, particularly from states,
localities, Tribal governments, and rural
and urban medical centers, about any
broadband-enabled health IT programs
that have been developed and
implemented (or will soon be
implemented) to reach these areas. How
successful have those programs been?
What are some of the lessons learned in
developing those programs? What
programs and other efforts are necessary
to drive attention to those rural and
underserved populations that need
health technologies most? How can the
Commission better facilitate the
deployment of services and technologies
as well as consumer adoption in those
areas?
8. We seek suggestions on ways the
Task Force can effectively and
efficiently identify any gaps in the
availability of broadband-enabled health
technologies in the country. We request
any information, data, or studies that
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jstallworth on DSK7TPTVN1PROD with PROPOSALS
can better inform the Task Force as to
where broadband-enabled health
services and technologies are critically
needed in the country but are
insufficient or unavailable. Why do
these availability gaps exist? Maps and
data—including those commissioned by
or for states or localities—would be
particularly helpful. In August of 2016,
the Task Force launched one such
broadband health analytics tool—the
Mapping Broadband Health in America
platform—to allow stakeholders to more
easily analyze and study the
intersection between connectivity and
health for every state and county in the
United States. While the response to the
platform—from other federal agencies,
as well as private organizations and
industry—has been uniformly positive,
with some already using the mapping
platform to improve data-driven
decision-making around broadband
health-related policies and initiatives,
we seek additional stakeholder input.
How can we further improve the
analytic platform to encourage
investment in broadband health
networks in areas with the greatest
health and connectivity needs? If we
wanted to refine the tool to identify
potential partnerships among health
care providers or between health care
providers and broadband service
providers, what is the best way to
achieve that goal?
9. What are the impediments to
making health IT and other broadband
health technology services available and
ubiquitous in rural and remote areas,
low population density areas, Tribal
lands, and underserved urban sectors?
Are there any unique challenges that
persist in these areas; if so, what are
they? In particular, we seek comment on
any deployment, infrastructure,
geographic, expertise (e.g., the
availability and adequacy of IT
expertise), telecommunications carrier
availability, cost, and any other
challenges in these areas. We seek
suggestions for how to address such
challenges, including on any rule and/
or policy changes that the Commission
should consider.
Objective II: Identify Regulatory Barriers
(and Incentives) to the Deployment of
RF-Enabled Advanced Health Care
Technologies and Devices
The Commission has a long history of
addressing spectrum needs for the
development of next- generation health
technologies and medical devices, and
of exercising flexibility, as necessary
and appropriate, in revising its rules
and policies to speed up their
deployment. However, in recent
months, stakeholders in the health
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sector and commercial wireless industry
have raised concerns about the likely
surge in demand for spectrum for
wireless medical devices and
broadband-enabled services—noting
trends toward fully connected hospitals,
widespread remote patient monitoring,
and leveraging connectivity to improve
health facilities’ workflow and backoffice functions—and have sought
appropriate regulatory relief. Most
recently, in August 2016, TerreStar
Corporation filed a request for waiver of
its substantial service requirements to
enable use of its wireless licenses in the
1.4 GHz band to provide wireless
medical telemetry service (WMTS)
operations, citing increasing demand.
Several wireless medical device
manufacturers supported the waiver
request and argued that there was a
spectrum shortage facing WMTS
licensees.
Below, we seek information and data
on (i) the types of broadband-enabled
health technologies and medical devices
currently in the market and those that
may be launched in the near future; (ii)
the future spectrum and wireless
infrastructure needs in the health care
sector; and (iii) any concerns about the
increased use and proliferation of
wireless medical devices in health care
settings and public spaces. Also, we
welcome comment on what, if any,
regulatory barriers exist (as well as
incentives that could be implemented)
concerning the deployment of advanced
broadband-enabled health care
technologies and medical devices. For
purposes of this Document, we are only
seeking information on ‘‘medical
devices’’ that use RF wireless
technology or communications
functions for diagnosis, treatment, or
patient monitoring.
10. We seek information on the types
of broadband-enabled health
technologies and medical devices that
are currently in the market. In addition,
what emerging types of broadbandenabled health technologies and
medical devices are likely to be
available to consumers soon? What are
the future trends in this market area?
11. What, if any, technical issues or
concerns exist for patients and other
users of medical devices when such
devices are used in hospital settings? Do
these concerns vary depending on the
type and size of the hospital setting? Are
these concerns exacerbated when
medical devices are operating in large or
busy hospital environments (which may
include a wide variety of wireless
technologies, some of which may be
unrelated to clinical care); if so, what
are those concerns, how can they be
addressed?
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12. Similarly, what, if any issues or
concerns exist for patients and other
users of medical devices when such
devices are used primarily in potentially
uncontrolled, non-hospital settings (e.g.,
in homes, aircraft, cruise ships, or other
close quarter, multi-unit dwellings,
etc.), where non-health related wireless
technologies that also emit radio
frequencies (e.g., baby monitors,
wireless home security systems, Wi-Fi
routers, etc.) may proliferate? And to
what extent might similar issues or
concerns exist for emerging and future
technological innovations (e.g., electric
automobiles, smart cars, smart homes,
etc.)?
13. We seek comment, data, and any
studies on the possible complexities of
the future RF environment in homes,
hospitals, and other public spaces
related to the increasing number of
medical applications and devices.
14. How are medical devices currently
being tested and evaluated to ensure
that consumers and patients can safely
use them in both clinical and nonclinical settings, given their operation in
varied spectrum environments? Are
there currently any FCC rules or policies
that serve as barriers to testing and
deployment of advanced health care
technologies and medical devices? If
any, please identify which specific rules
and/or policies, and explain how they
have served to impede the testing and
deployment of health care technologies
and medical devices. How might the
Commission address such concerns?
15. We also request recommendations
on how the Commission could make an
assessment of the spectrum and wireless
infrastructure needs for the future of
health care in the United States. We
seek input from all relevant
stakeholders, including members of the
health care, wireless, and software
industries who are developing wireless
healthcare applications for the present
and future; physicians, consumer
advocates, and academicians; and
relevant federal, state, and local
government agencies. While we
envision building upon the spectrum
management and wireless infrastructure
deployment policies that the FCC has
successfully employed in the past to
promote innovation in wireless health
services, we ask commenters to identify
any novel framework, including those
that might include smart city initiatives
or public/private partnerships, that
could be useful in planning for the
wireless future of our nation’s health
care system.
a. One of the compelling drivers of
mobile technology in healthcare is the
increasing availability of health apps for
smartphones and tablets. There is now
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an app for almost every conceivable
healthcare need, ranging from drug dose
calculators to fully functioning
electronic medical records. We are also
seeing the development of smart homes
and automobiles that would enable even
more sophisticated remote health
monitoring. How soon will we see
widespread adoption of these
technologies and what implications will
they have on the spectrum needs of the
health care industry?
b. In developing a national spectrum
plan for the health care industry, are
there particular spectrum bands that the
FCC should consider?
c. When it comes to increased need
for spectrum-based health technologies,
what challenges do small, rural, and
critical access hospitals have that are
different from what large hospitals face?
d. Do health care facilities, because of
their different physical characteristics,
require different types of small cells and
wireless infrastructure than other
commercial enterprises? What are the
most challenging impediments to the
deployment of wireless infrastructure in
hospitals and health care systems? What
policies should the FCC consider in
order to help streamline infrastructure
siting that is necessary for the
deployment of wireless networks in
hospitals and health care systems? What
state or local government regulatory
policies have helped to facilitate
streamlined deployment of wireless
infrastructure for health care?
e. How can new advanced spectrum
sharing techniques (e.g., dynamic
spectrum sharing through database
controlled coordination, software
designed radios, or efficient spectrum
use through network virtualization
techniques) or secondary market
mechanism (e.g., spectrum leasing
arrangements) be leveraged to meet the
spectrum demands of cutting-edge
mobile broadband-enabled health
technologies and medical devices that
may be operating in varied spectrum
environments? Are there any issues
with harmonization of spectrum for
medical uses across international
borders to ensure that consumers can
effectively and safely use medical and
other devices across borders?
f. What are some of the recent and
emerging trends in health care delivery
(in rural and urban areas) that are
implicating spectrum use and needs?
Are these trends creating a greater need
for spectrum wireless services,
particularly in rural areas? Are these
trends resulting in increased use of
remote patient monitoring solutions?
16. Do any regulatory barriers exist
concerning the deployment of advanced
broadband-enabled health care
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technologies and medical devices? We
also welcome suggestions on any
regulatory incentives (that are within
the FCC’s authority) that could serve to
foster continued investment in and
further deployment of next-generation
broadband-enabled health technologies
and medical devices?
Objective III: Strengthen the Nation’s
Telehealth Infrastructure Through the
FCC’s Rural Health Care Program and
Other Initiatives
Broadband deployment is one of the
FCC’s top priorities, particularly in rural
America. Based on current evidence,
broadband can be a game-changer
particularly in rural areas—where
consumers often have to drive long
distances to access critical or specialty
care; and where isolated clinics and
health centers can save lives and
promote community health by using
advanced communications technologies
to connect with medical expertise not
otherwise available, as well as monitor
patients who live many miles away from
a health care facility.
The FCC’s Rural Health Care (RHC)
Program has helped expand broadband
services for eligible health care
providers (HCPs) in rural areas.
Currently, the RHC Program is
comprised of three programs: The
Healthcare Connect Fund (HCF), the
Telecommunications Program, and the
Pilot Program. With respect to the Pilot
Program, while no new funding is
available, some projects continue to
accept new HCP sites. As funding for
the Pilot Program projects ends, Pilot
Program projects are expected to apply
for additional support, if needed, under
the Healthcare Connect Fund. The FCC
established the Healthcare Connect
Fund to expand health care provider
access to broadband, especially in rural
areas, and encourage the creation of
state and regional broadband health care
networks. Under the Healthcare Connect
Fund, eligible rural HCPs, and those
non-rural HCPs that are members of a
consortium that has a majority of rural
HCP sites, can receive a 65 percent
discount from the fund on all eligible
expenses. HCPs are required to
contribute the remaining 35 percent to
participate in the program. HCPs can
use the Healthcare Connect Fund to
purchase eligible services and
equipment, as well as construct their
own broadband infrastructure where it
is shown to be the most cost effective
option. The cap on total funding for the
RHC Program altogether, which
includes the Telecommunications
Program and the Healthcare Connect
Fund, is $400 million annually.
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The Commission’s RHC Program has
made the benefits of broadband-enabled
health services, such as telehealth and
telemedicine, more available to
consumers living in rural and remote
areas. Such broadband-enabled services
have provided patients in rural areas
with access to critically needed medical
specialists in a variety of practice areas.
The availability of telehealth and
telemedicine programs also has been
found to mitigate significant challenges
associated with disparities in access to
care and healthcare workforce shortages.
The RHC Program also has been found
to save health care providers money as
well. The Commission continues to
evaluate the Healthcare Connect Fund
(HCF) in terms of the programmatic
goals of (1) increasing access to
broadband for HCPs, particularly those
serving rural areas; (2) fostering the
development and deployment of
broadband health care networks; and (3)
maximizing the cost-effectiveness of the
program.
17. We seek comment and suggestions
on how the FCC can further promote
and help enable the adoption and
accessibility of broadband-enabled
health technologies, like telehealth and
telemedicine, in rural and other
underserved areas. Are there other
initiatives or actions beyond the RHC
Program that the agency, or the Task
Force on behalf of the agency, could
pursue in order to promote and help
enable the adoption and availability of
broadband-enabled health technologies
in rural and underserved areas of the
country?
18. Is the regulatory framework for the
Rural Health Care program keeping pace
with how broadband-enabled health
care is being delivered in rural and
underserved areas? If not, please explain
in detail, describing any emerging
challenges, gaps or opportunities for
using broadband to better meet the
health and health care needs of rural
consumers.
19. We seek current information and
data, if any, that can be used to measure
the impact that the various RHC
programs have had on certain
populations and sectors—i.e., those
living in rural and underserved areas,
low density populations, and Tribal
lands; older Americans; persons with
disabilities; military veterans; and the
economically disadvantaged in rural
and urban communities—all of which
have traditionally faced significant
health and health care challenges.
20. We also are interested in hearing
recent success stories about innovative
health care services that were created or
that became available as a result of the
RHC Program, and how such services
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have helped consumers in rural and
remote areas. We are particularly
interested in receiving data and
information about health outcomes,
return on investment, and the ability to
reach such underserved population
groups. First-person accounts are
welcomed.
21. We seek information, data, and
studies that identify specific rural areas
and underserved regions of the country
that need funding assistance for the
purchase of high-capacity broadband
connectivity, connections, and any
other services or equipment authorized
under the RHC Program rules. We seek
detailed information and data as to
whether eligible health care providers in
these areas and regions that require
funding assistance have participated in
the RHC Program, and if not, why not.
We also seek suggestions on how the
Commission can encourage or facilitate
their participation. Are there specific
challenges of which the Commission
should be aware?
22. The Task Force is interested in
identifying all currently available public
(federal, state, or local) and private (e.g.,
non-profit or philanthropic
organizations) funding sources for the
provision of broadband-enabled health
technologies and services (e.g.,
telehealth and telemedicine) in rural
regions, Tribal lands, and in other
underserved areas (including
underserved urban areas), as well as for
vulnerable populations. Please provide
information about those funding
sources, as well as their Web site
address, if any.
23. We seek any other comment,
information, and data concerning the
RHC Program as well as the general
needs of rural consumers for broadbandenabled health solutions that would be
helpful to the Task Force, given its
charge and objectives.
Objective IV: Raise Consumer
Awareness About the Value Proposition
of Broadband in the Health Care Sector
and its Potential for Addressing Health
Care Disparities
It is critically important that
consumers fully understand the
practical and personal benefits of
broadband in health care and in
facilitating greater care coordination,
proactive engagement in disease
prevention, and self-management.
Placing more care decisions in the
hands of consumers and personalizing
that experience appears to be a major
theme in health applications and
product development today. We also
recognize that as consumers fully realize
the practical health benefits of
broadband, consumer demand for
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broadband-enabled health services and
technologies will serve to further
accelerate broadband deployment and
adoption altogether—a national priority.
24. We seek suggestions on how the
Commission can effectively increase
consumer awareness about the value
proposition of broadband in the health
care sector? Are there any practical
efforts that the Commission can
undertake to accelerate consumer
adoption of broadband, and in
particular broadband-enabled health
services and technologies, especially
among underserved populations? How
might the Commission ensure that
certain groups—e.g., rural consumers,
those living on Tribal lands, older
Americans, people with disabilities,
military veterans, non-English speakers,
and the economically disadvantaged—
are fully aware of the availability and
benefits of broadband-enabled health
services and technologies? Are there any
states, cities, and organizations engaged
in similar efforts that could lead to
potential partnerships?
25. We also seek comment on any
concerns that may discourage
consumers, health care providers, and
others from adopting broadbandenabled health services and other
advanced health technologies, including
telehealth and telemedicine services
and emerging medical devices. To what
extent do safety, security, reliability,
and privacy concerns influence
adoption of broadband-enabled health
services and other advanced
technologies? To what extent do costs,
socioeconomic status, and digital
literacy issues impact adoption?
26. We request information on any
studies, pilots, research, or other data
that quantifies the benefits of
broadband-enabled health technologies
in improving patient outcomes and in
reducing costs. What kind of return on
investment have pilot and
demonstration projects experienced?
27. We are interested in learning how
broadband can enable healthcare-related
support systems to connect patients to
the people, services and information
they need to get well and stay healthy.
In this regard, physicians inform us that
there is growing recognition that the
need for social services and supports
(e.g., nutritionists, dieticians,
pharmacists, family caregivers, fitness
centers, and other health care supports
or supporters outside the traditional
hospital setting) significantly impact the
ability of some consumers to become
healthy and stay well, and that the
availability of broadband is increasingly
essential to bridging the various services
and supports. We seek comment and
suggestions on how the Commission can
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support the development and
availability of these new broadbandenabled services and supports (outside
the RHC Program) especially on Tribal
lands and in rural, remote, and other
underserved areas?
28. We seek information and any
studies about how broadband-enabled
services and technologies have been,
and could be used, to address health
and health care disparity issues, and the
impact (and successes) such services
and technologies have had in addressing
such issues.
29. Are there any practical issues (e.g.,
the lack of a home computer) that may
be impeding consumer awareness and
adoption of broadband-enabled health
technologies? What efforts can be
undertaken to help alleviate some of
these issues?
Objective IV: Enable the Development of
Broadband-Enabled Health
Technologies That are Designed to be
Fully Accessible to People With
Disabilities
The availability and accessibility of
broadband-enabled health technologies
designed to serve the needs of
Americans with disabilities is critically
important. One recent study estimates
that, in 2013, the overall percentage of
people with a disability in the U.S.,
among the civilian noninstitutionalized
population, was 12.1 percent or
approximately 37 million people. Other
studies suggest that the number is
higher than 50 million, and that it is
predicted to continue to increase. Given
these statistics, it is imperative that we
do what we can, within our statutory
authority, to promote the goal of making
broadband-enabled health technologies
and cutting-edge health and medical
devices and applications available,
accessible, and usable by people with
disabilities.
Technology has historically played an
important role in the disability
community. Many people with
disabilities use communications
technology, devices, or services in their
daily lives, and broadband is becoming
an essential data transmission platform
that enables a wide range of services
and tools. Ensuring that people with
disabilities are able to access electronic
health records, engage in video
consultation with their physicians, fully
utilize the latest health apps, and
benefit from advances in wearable
health technology, for example, are
essential to the ongoing health care
transformation. Consistent with its
charge, the Task Force will consider the
extent to which broadband-enabled
services and technologies used for the
provision of health and care are
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available, accessible, and usable by all
Americans, including those with
disabilities. We therefore seek any data,
information, and comment that will
assist the Commission in better
understanding how it may assist in
achieving these important goals.
30. How are broadband-enabled
health technologies and medical devices
currently being used by people with
disabilities? To what extent can these
technologies and devices address the
health care needs of people with
disabilities in the future? Provide
specific examples of the existing
barriers, if any, that these technologies
and devices pose for people with
disabilities.
31. We seek comment on whether the
design and development of broadbandenabled health services and
technologies, as well as cutting-edge
health and medical devices and
applications, are accessible to, and
usable by, people with disabilities. Are
there practical concerns or other issues
that are inhibiting or limiting the use
and availability of broadband-enabled
health services and technologies for
people with disabilities? How are
hospitals and clinicians currently
addressing, if at all, any of these issues?
An increasing number of health care
services provide patient portals for
patients to access medical records and
communicate with physicians and
specialists. What measures are taken to
ensure that these mechanisms are fully
accessible to users with disabilities (e.g.,
accessible via screen readers used by
individuals who are blind)?
32. To what extent are clinicians
aware of video relay service (VRS) and
using it when remotely consulting with
American Sign Language (ASL) users on
a telephone call? Is there a need for VRS
providers to have ASL interpreters with
a knowledge of (and ability to translate)
specialized health or medical
vocabulary? Should a VRS call that
involves consultations between a deaf or
hard of hearing person and a doctor be
given priority over other calls waiting in
a queue, especially when there is a
possible medical emergency? We also
seek comment as to whether our
telecommunications relay service (TRS)
rules are currently optimized to
encourage medical consults via
telemedicine?
33. We seek suggestions as to how the
Commission can effectively raise
awareness among people with
disabilities about the value proposition
of broadband in health? How can the
Commission help to enable the adoption
and accessibility of such services and
technologies among people with
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disabilities, especially given our
authority?
Objective VI: Highlight Effective
Telehealth Projects, Broadband-Enabled
Health Technologies, and mHealth
Applications Across the Country and
Abroad—To Identify Lessons Learned,
Best Practices, and Regulatory
Challenges
Related to the objective of increasing
consumer awareness about the practical
health-related benefits of broadband is
the need to inform the public—
especially those in rural and
underserved regions—about the
availability and successes of the many
broadband-enabled telehealth and
telemedicine centers and projects across
the country and abroad, as well as
existing and emerging mHealth
applications, and to identify lessons
learned and best practices.
34. We seek current information and
data on the effectiveness of broadbandenabled telehealth and telemedicine
services, including any recent research
on these services. How are patients
responding to these services? We are
particularly interested in receiving
comments directly from consumers
about their experience with these and
other broadband-enabled services and
technologies.
35. We also seek comment on specific
challenges faced by states, localities,
and Tribal governments, as well as
communities abroad, in deploying
effective broadband-enabled telehealth
and telemedicine projects.
36. We seek comment on how the
public can be better informed about the
availability of broadband-enabled health
services and technologies and mHealth
applications. What have states,
localities, other federal agencies, Tribal
governments, and hospitals and clinics
done to inform the public about the
availability of these options? How
effective have these projects been in
promoting greater broadband
utilization?
37. We seek submissions of any case
studies, research and video/audio
summaries concerning recently
launched applications/programs that are
on the cutting edge of telehealth,
telemedicine, mHealth, and other
broadband-enabled health technologies
and services.
38. We seek comment on the extent to
which the United States is not taking
full advantage of the opportunities that
broadband-enabled health technology
provides. For countries that have been
the most successful in making
broadband-enabled health services and
technology more widely available,
especially in rural and underserved
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areas, we seek information on the
approaches that such countries took
(including lessons learned) in achieving
success in broadband health adoption.
Objective VII: Engage a Diverse Array of
Traditional and Non-Traditional
Stakeholders To Identify Emerging
Issues and Opportunities in the
Broadband Health Space
Published reports indicate that the
‘‘the health IT industry is gaining a
reputation as an emerging sweet spot for
technology investors.’’ We want to be
sure that Commission policies do not
present obstacles to continued
innovation and investment in
broadband-enabled health technologies,
including medical devices that rely on
communications technology. We
observe that there is a growing desire for
such technologies—including those that
are wearable or otherwise track and
monitor personal health—and that this
emerging health market is estimated to
be worth billions. There are also
countless smartphone apps that track
health-related issues. By some
estimates, there are over 100,000 digital
health apps offered in the three major
app stores. In addition, recent advances
in broadband-enabled sensor technology
offer the potential for the emergence of
more convenient and ultimately less
costly and less invasive health care
solutions. For example, we may soon
see the widespread use of smart clothing
(or smart ‘‘tattoo’’ applications) that use
skin-based sensors to measure things
like heart rate, respiration, and blood
pressure. Robotics, virtual reality, and
other consumer facing health
technologies also offer the potential to
help older Americans live more
independently. Some technology
companies are even experimenting with
combining web search with online
health consultations for a one-stop
offering. To help inform the
Commission in its related and other
efforts in this area, we seek comment
and information on these and other
emerging health technologies,
applications, services, and connected
medical devices.
39. We seek comment on any
emerging issues of concern (that have
not been identified in this Document)
that potentially impact efforts to
accelerate the availability of broadbandenabled health technologies and
services, as well as medical devices that
rely on communications technology.
40. While the United States has made
great strides in recent years, many
advances in digital health technologies
are still not broadly available, widely
utilized, or well-tailored to meet the
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needs of all Americans. We seek
comment on these concerns.
41. What are the emerging
opportunities for investors, innovators,
and entrepreneurs in the broadband
health space and in the development of
the next generation of connected health
technologies and converged medical
devices? We seek suggestions on any
efforts that the Commission might
undertake to support innovation and
entrepreneurship in these areas. Are
there emerging or non-traditional
stakeholders that should be part of the
Commission’s efforts? If so, please
identify them and their respective roles
in or contributions to the broadband
health space.
42. We seek comment on how to
promote small and diverse investors,
innovators, and entrepreneurs in the
broadband health sector in order to
better ensure that the benefits of
broadband-health technologies and
services are available to all Americans.
43. We seek to engage all potential
stakeholders in this national broadband
health effort. Commenters should
identify any additional stakeholders that
are not specifically referenced in this
Document. We also encourage parties to
identify any other relevant issues (not
covered in this Notice) for the Task
Force, given its charge and objectives.
Administrative Matters. Because this
Document does not itself initiate a
‘‘proceeding,’’ responses to the
Document are not ‘‘presentations’’
subject to the prohibitions in restricted
proceedings and the disclosure
requirements in permit-but-disclose
proceedings. Nonetheless, parties
discussing or providing information to
the Task Force or any other members of
the Commission regarding the issues
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raised in this Document are strongly
encouraged to file a memorandum in the
docket, summarizing their discussion
and/or information.
Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 2017–09309 Filed 5–9–17; 8:45 am]
BILLING CODE 6712–01–P
Replies to an opposition must be filed
on or before May 26, 2017.
Federal Communications
Commission, 445 12th Street SW.,
Washington, DC 20554.
ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
Mark Montano, Wireless
Telecommunications Bureau, (202) 418–
0691, email: mark.montano@fcc.gov.
This is a
summary of Commission’s document,
Report No. 3077, released May 1, 2017.
The full texts of the Petitions are
available for viewing and copying at the
FCC Reference Information Center, 445
12th Street SW., Room CY–A257,
Washington, DC 20554 or may be
accessed online via the Commission’s
Electronic Comment Filing System at
https://apps.fcc.gov/ecfs/. The
Commission will not send a
Congressional Review Act (CRA)
submission to Congress or the
Government Accountability Office
pursuant to the CRA, 5.U.S.C. because
no rules are being adopted by the
Commission.
Subject: Connect America Fund;
Universal Service Reform—Mobility
Fund, Report and Order, FCC 17–11,
published at 82 FR 15422, March 28,
2017, in WC Docket No. 10–90 and WT
Docket No. 10–208. This document is
being published pursuant to 47 CFR
1.429(e). See also 47 CFR 1.4(b)(1) and
1.429(f), (g).
Number of Petitions Filed: 7.
SUPPLEMENTARY INFORMATION:
FEDERAL COMMUNICATIONS
COMMISSION
47 CFR Parts 1 and 54
[WC Docket No. 10–90, WT Docket No. 10–
208; Report No. 3077]
Petitions for Reconsideration and/or
Clarification of Action in Rulemaking
Proceeding
Federal Communications
Commission.
ACTION: Petitions for reconsideration
and/or clarification.
AGENCY:
Petitions for Reconsideration
and/or Clarification (Petitions) have
been filed in the Commission’s
rulemaking proceeding by Caressa D.
Bennet, on behalf of Rural Wireless
Association, Inc.; Krista L. Witanowski,
on behalf of CTIA; Brian Gelfand, on
behalf of Buffalo-Lake Erie Wireless
Systems, L.L.C. (Blue Wireless); Robert
A. Silverman, on behalf of Panhandle
Telephone Cooperative, Inc. and Pine
Belt Cellular, Inc.; John Prendergast, on
behalf of the Blooston Rural Carriers;
David A. LaFuria, on behalf of Rural
Wireless Carriers; and Cathleen A.
Massey, on behalf of T-Mobile USA, Inc.
DATES: Oppositions to the Petitions
must be filed on or before May 16, 2017.
SUMMARY:
PO 00000
Frm 00047
Fmt 4702
Sfmt 9990
Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 2017–09462 Filed 5–9–17; 8:45 am]
BILLING CODE 6712–01–P
E:\FR\FM\10MYP1.SGM
10MYP1
Agencies
[Federal Register Volume 82, Number 89 (Wednesday, May 10, 2017)]
[Proposed Rules]
[Pages 21780-21788]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-09309]
-----------------------------------------------------------------------
FEDERAL COMMUNICATIONS COMMISSION
47 CFR 1, 15, 20, and 54
[GN Docket No. 16-46; FCC 17-46]
FCC Seeks Comment and Data on Actions To Accelerate Adoption and
Accessibility of Broadband-Enabled Health Care Solutions and Advanced
Technologies
AGENCY: Federal Communications Commission.
ACTION: Request for comments.
-----------------------------------------------------------------------
SUMMARY: The Federal Communications Commission (FCC) seeks comment,
data, and information on a variety of regulatory, policy, and
infrastructure issues related to the emerging broadband-enabled health
and care ecosystem. The FCC seeks to ensure that consumers--from major
cities to rural and remote areas, Tribal lands, and underserved
regions--can access potentially lifesaving health technologies and
services, like telehealth and telemedicine, which are enabled by
broadband connectivity. The anticipated record will allow the
Commission and its Connect2HealthFCC Task Force (Task Force) to gain a
broader understanding about the current state of broadband health
connectivity. The record will also be used by the Task Force to make
future recommendations to the Commission.
DATES: Submit comments on or before May 24, 2017, and reply comments on
or before June 8, 2017.
ADDRESSES: You may submit comments, identified by GN Docket No. 16-46,
by any of the following methods:
Electronic Filers: Comments may be filed electronically
using the Internet by accessing the ECFS: https://apps.fcc.gov/ecfs/
(click the ``submit a filing'' tab). Filers should follow the
instructions provided on the Web site for submitting comments. For ECFS
filers, in completing the transmittal screen, filers should include
their full name, U.S. Postal service mailing address, and the
applicable docket number: GN Docket No. 16-46.
Paper Filers: Parties who choose to file by paper must
file an original and one copy of each filing. Filings can be sent by
hand or messenger delivery, by commercial overnight courier, or by
first-class or overnight U.S. Postal Service mail. All filings must be
addressed to the Commission's Secretary, Marlene H. Dortch, Office of
the Secretary, Federal Communications Commission. All hand-delivered or
messenger-delivered paper filings for the Commission's Secretary must
be delivered to FCC Headquarters at 445 12th St. SW., Room TW-A325,
Washington, DC 20554. All hand deliveries must be held together with
rubber bands or fasteners. Any envelopes must be disposed of before
entering the building. The filing hours are 8:00 a.m. to 7:00 p.m.
Commercial overnight mail (other than U.S. Postal Service Express Mail
and Priority Mail) must be sent to 9300 East Hampton Drive, Capitol
Heights, MD 20743. U.S. Postal Service first-class mail, Express Mail,
and Priority Mail must be addressed to 445 12th Street SW., Washington,
DC 20554.
Additional Filing Instruction: To the extent feasible, parties
should email a copy of their comments to the Task Force's email box, at
connect2health@fcc.gov. In the email, please insert ``Comments in GN
Docket No. 16-46'' in the subject line. Copies of all filings will be
available in GN Docket No. 16-46 through ECFS and are also available
for public inspection and copying during regular business hours at the
FCC Reference Information Center, Portals II, 445 12th St. SW., Room
CY-A257, Washington, DC 20554, telephone (202) 418-0270. Documents will
be available electronically in ASCII, Microsoft Word, and/or Adobe
Acrobat.
People with Disabilities: To request materials in accessible
formats for people with disabilities (braille, large print, electronic
files, audio format), send an email to fcc504@fcc.gov or call the
Consumer and Governmental Affairs Bureau at 202-418-0530 (voice) or
202-418-0432 (TTY). Contact the FCC to request reasonable
accommodations for filing comments (accessible format documents, sign
language interpreters, CART, etc.) by email at: fcc504@fcc.gov; phone:
202-418-0530 or TTY: 202-418-0432.
FOR FURTHER INFORMATION CONTACT: For further information about this
Document, please contact Ben Bartolome, Special Counsel,
Connect2HealthFCC Task Force, at (770) 935-3383, or via email at
connect2health@fcc.gov (inserting ``Question re GN Docket No. 16-46''
in the subject line). Press inquiries should be directed to Katie
Gorscak, Communications Director, Connect2HealthFCC Task Force, at
(202)
[[Page 21781]]
418-2156, or via email at Katie.Gorscak@fcc.gov. For additional
information about the Connect2HealthFCC Task Force, please visit the
FCC's broadband health hub at https://www.fcc.gov/health.
SUPPLEMENTARY INFORMATION: This is a summary of the Commission's
document, FCC 17-46, in GN Docket No. 16-46, released on April 24,
2017. The full text of this document is available on the Internet at
the Commission's Web site, at https://www.fcc.gov/document/fcc-seeks-comment-accelerating-broadband-health-tech-availability; and it is also
accessible from the Connect2HealthFCC Task Force's Web page, at https://www.fcc.gov/health/public-notice. The full text is also available for
public inspection and copying from 8:00 a.m. to 4:30 p.m. Eastern Time
(ET) Monday through Thursday or from 8:00 a.m. to 11:30 a.m. on Fridays
in the FCC Reference Information Center, 445 12th Street SW., Room CY-
A257, Washington, DC 20554 (Telephone: 202-418-0270; TTY: 202-418-
2555).
Overview
Broadband networks are increasingly important to our national well-
being and everyday lives. As such, we must maximize their availability
and ensure that all Americans can take advantage of the variety of
services that broadband enables, including 21st century health care. In
this Document, the FCC seeks information on how it can help enable the
adoption and accessibility of broadband-enabled health care solutions,
especially in rural and other underserved areas of the country. We
expect to use this information to identify actions that the Commission
can take to promote this important goal.
Ensuring that everyone is connected to the people, services, and
information they need to get well and stay healthy is an important
challenge facing our nation. Technology innovations in clinical
practice and care delivery coupled with burgeoning consumer reliance on
mHealth and health information technology (or healthIT) are
fundamentally changing the face of health care, and a widespread,
accessible broadband infrastructure is critical to this ongoing shift.
Indeed, the future of modern health care appears to be fundamentally
premised on the widespread availability and accessibility of high-speed
connectivity. By some estimates, broadband-enabled health information
technology can help to improve the quality of health care and
significantly lower health care costs by hundreds of billions of
dollars in the coming decades. However, the United States remains
behind some advanced countries in the adoption of such technology.
As discussed in this Document, the Commission plays an important
role in improving the quality of health care and enabling health care
innovation through the universal service program, spectrum licensing,
and other activities. In order to perform these and other important
roles in the health technology space, the Commission should continue to
evaluate the nation's broadband health infrastructure and to understand
the ongoing technology-based transformation in health care delivery.
This will better assure that consumers--from major cities to rural and
remote areas, Tribal lands, and underserved regions--can access
potentially lifesaving health technologies and services, like
telehealth and telemedicine. Leading this effort on behalf of the
agency is its Connect2HealthFCC Task Force. Among other things, the
Task Force is charged with charting the broadband future of ``health
and care'' in order to ensure that the agency stays ahead of the health
technology curve. We use the phrase ``health and care'' deliberately in
this Document to reflect and include the broad range of participants in
the emerging broadband health ecosystem, including providers (e.g.,
health systems, community health centers, clinicians, pharmacists,
nutritionists, allied health professionals); public health and social
service agencies and organizations; innovators and entrepreneurs;
academic and research facilities; state and local policymakers;
patients and their caregivers; as well as consumers who seek support to
prevent disease and maintain optimum health.
This Document seeks comment, data, and information on a broad range
of regulatory, policy, technical, and infrastructure issues related to
the emerging broadband-enabled health and care ecosystem. Commenters
should address the agency's authority on all issues raised in this
Notice. The comment, data, and information requested are intended to
provide the Commission with a broader understanding and perspective on
the current state of broadband health technology and other related
issues; and it will also inform the Task Force's work and
recommendations.
The Broadband Health Imperative
Broadband holds promise for enabling health care solutions and
advanced technologies that can help to meet America's growing health
care needs. Health care accounts for a significant percentage of the
U.S. gross domestic product and health care costs are projected to
increase. Studies confirm that the United States has a serious health
care supply problem. By some estimates, the country could face a
shortage of up to 94,700 physicians by 2025, and the forecast is worse
for rural communities. The healthcare provider shortfall is likely to
disproportionately affect rural and remote areas which are already
medically-underserved.
At the same time, demand for health care services is increasing.
Today, over 320 million people in the United States could, at any time,
utilize health care services, with one person added every 12 seconds
(net), yet we only have approximately 280,000 primary care physicians
to meet the needs. By the year 2060, the number of people living in the
United States is projected to increase by 100 million (resulting in a
total of 425+ million people), further exacerbating the projected
physician shortage concern. To further complicate matters, over 100
million Americans are dealing with chronic diseases and conditions
(e.g., heart disease, stroke, cancer, obesity, diabetes, and
arthritis); and despite best efforts, health care disparities persist
across various geographic regions and ethnic groups. While many
individuals struggle with one chronic illness, older Americans often
face from two to as many as five chronic diseases at the same time. By
2030, one out of every five Americans (or 71 million) will be over the
age of 65, and 20 million will be over the age of 80.
While broadband is not a complete answer, there are a growing
number of broadband-enabled solutions that can play an important role
in improving population health; addressing health needs beyond the
hospital; expanding access to primary, acute, preventive and specialist
care, especially for those Americans living in rural and underserved
areas; providing more cost-effective solutions; improving the quality
of care; and better engaging consumers in their health. Put simply,
health care is being transformed by the availability and accessibility
of broadband-enabled services and technologies and the development of
life-saving wireless medical devices.
Indeed, we are already realizing some of the tremendous benefits
that broadband-enabled health technologies and innovative wireless
medical devices have to offer: Electronic Health Record (EHR) systems
can track and transmit vast amounts of patient clinical data. X-rays,
MRIs, and CAT scans can be transmitted seamlessly to specialists at a
distant hospital. Telemedicine and
[[Page 21782]]
telehealth programs and services provide opportunities to close access
to care gaps and facilitate specialized training. Medical providers are
able to prescribe medications electronically, saving time and money.
Surgeons are able to perform operations miles away from patients via
robotics. Self-service health kiosks are becoming increasingly
available at pharmacies and grocery chains, providing additional access
points for primary care and disease screenings. Remote patient
monitoring applications and services are reducing hospital readmissions
as well as travel and associated expenses for patients. Mobile devices
like smartphones and personal data assistants are transforming the way
physicians manage patient care; they are also empowering and engaging
consumers to take a more active role in managing their own health.
Implant or body-worn monitoring, therapeutic, and treatment
technologies include wireless blood glucose monitors and automated
insulin pumps. ``Ingestibles'' and ``smart pills'' (broadband-enabled
digital tools that are swallowed by the patient) use wireless
technology to monitor internal reactions in real-time, dispense
medication, and provide other granular health data.
Veterans, in particular, have seen tangible benefits from
telemedicine. Most notably, critical mental health services are now
accessible via telemedicine to those veterans living in rural areas or
abroad. In fiscal year 2014, more than 690,000 military veterans
accessed the U.S. Department of Veterans Administration's (VA) health
care network using telemedicine programs, reflecting more than 1.7
million episodes of care. The Veterans Health Administration notes that
``[telemedicine] technology is now considered `mission critical' for
effectively delivering quality healthcare to veterans, particularly for
those in rural or underserved areas.''
These are just some of the opportunities that broadband-enabled
services and health-related communications technologies and devices
offer, especially for those living in rural and underserved areas, low
density populations, and Tribal lands; for older Americans; persons
with disabilities; military veterans; and the economically
disadvantaged--all of whom have traditionally faced significant health
and care challenges. We endeavor to foster the development and
accessibility of these and other emerging communications-based
technologies throughout the country. The work ahead, however, can only
be successful if it combines the efforts of all levels of government,
industry, innovators and entrepreneurs, academia, consumers, and the
health care community. Accordingly, we seek broad public and private
stakeholder input and collaboration on the issues discussed below.
Request for Comment and Data
As part of its charge, the Connect2HealthFCC Task Force is focused
on the following objectives: (1) Promoting effective policy and
regulatory solutions that encourage broadband adoption and promote
health IT; (2) identifying regulatory barriers (and incentives) to the
deployment of radio frequency (RF)-enabled advanced health care
technologies and devices; (3) strengthening the nation's telehealth
infrastructure through the FCC's Rural Health Care Program and other
initiatives; (4) raising consumer awareness about the value proposition
of broadband in the health care sector and its potential for addressing
health care disparities; (5) enabling the development of broadband-
enabled health technologies that are designed to be fully accessible to
people with disabilities; (6) 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 (7) engaging a
diverse array of traditional and non-traditional stakeholders to
identify emerging issues and opportunities in the broadband health
space.
To continue evaluating these and other challenges, we request that
stakeholders and other interested parties provide comment, information,
and/or data on the issues and subject matter described below. This
Notice seeks the most current information available that is
specifically relevant to the intersection of broadband, advanced
technology, and health care in view of the aforementioned Task Force
objectives. For convenience, the issues for comment are enumerated; and
we request that parties, in their submission, identify the enumerated
issue to which their written response pertains. We also encourage
parties to identify any other relevant issues not covered below.
Objective I: Promote Effective Policy and Regulatory Solutions That
Encourage Broadband Adoption and Promote Health IT
Broadband and advanced technologies appear increasingly critical to
the effective transformation of our health care system. First, these
technologies enable the efficient exchange of patient and treatment
information by allowing providers to access patients' electronic health
records from on-site or hosted locations. Second, in many cases it can
remove geography and time as barriers to care by enabling telehealth
and telemedicine applications like video consultations and remote
patient monitoring. Third, broadband provides a foundation for the next
generation of medical devices, as well as other health innovation and
connected-care solutions. Finally, broadband-enabled health IT offers
real opportunities for consumers to take charge of their own health.
To ensure that these and other benefits continue to accrue and
expand, it is critical that we identify and engage in appropriate
efforts to address any current and emerging issues of concern. In this
regard, we note that there are some broad policy measures that, if
implemented, could accelerate broadband deployment generally, and
thereby provide greater access to broadband-enabled health
technologies, solutions and services, especially for those consumers
living in rural and underserved areas of the country. A prime example
is the possible establishment of ``Gigabit Opportunity Zones.'' In
September 2016, FCC Chairman Ajit Pai, as part of his Digital
Empowerment Agenda for accelerating the deployment of high-speed
Internet access, called on Congress to provide tax and other financial
incentives for the private sector to deploy gigabit broadband services
in low income neighborhoods, which he referred to as ``Gigabit
Opportunity Zones.'' More recently, the Commission created the
Broadband Deployment Advisory Committee (BDAC) to provide the
Commission advice on, among other things, accelerating broadband
deployment, identifying regulatory barriers to infrastructure
investment, and making recommendations for reducing and/or removing
regulatory barriers. We now seek additional and specific data regarding
the pace of deployment and adoption of broadband for health and in
health care. As detailed below, we also invite input on policies or
initiatives that the FCC could implement to further spur deployment and
adoption of broadband services, especially in critical need areas at
the intersection of health and broadband (e.g., the counties identified
in the Connect2HealthFCC Task Force's Priority 100 and Rural 100
lists).
1. We request suggestions regarding ways in which the FCC, based on
its authority, can further accelerate broadband adoption in the health
care context and promote broadband-enabled health IT solutions, either
on its own or
[[Page 21783]]
working in collaboration with other agencies, and, at the same time,
ensure that such services and technologies are fully available and
accessible to all Americans, including those living in rural and remote
areas, low density populations, Tribal lands, and in underserved urban
areas of our country. We also seek comment on what impediments to these
efforts exist, and how the FCC can address them.
2. We request information and data on the types, impact, scale, and
benefits of broadband-enabled services and technologies used for the
delivery of health care. How is broadband currently being used to
augment or transform existing health care delivery? What types of
health care settings are using broadband-enabled services and
technologies besides large medical hospitals? What variety of medical
issues are they used for? Where are these health care settings located?
What are some of the future plans for using broadband-enabled health
services and technologies--not just by clinicians and hospitals but
also by other participants in the broader health ecosystem?
3. We are also interested in learning how health technologies and
services can take advantage of new technological applications and
emerging communications networks. For example, what impact will the
Internet of Things (IoT) have on broadband-enabled health technologies
and services such as telehealth and telemedicine? To what extent will
pervasive connectivity and a fully connected environment around
individuals (e.g., IoT) shift the point of care delivery? How might the
demands on broadband networks evolve in this new environment? What, if
any, changes are anticipated in existing broadband-enabled health
services and technologies--operating over current mobile networks--when
5G (Fifth Generation Mobile and Wireless Networks) becomes available?
To what extent might telehealth and telemedicine be impacted by the
availability of 5G networks? What medical device innovations are
anticipated to be developed using 5G networks?
4. What technical issues concerning the variety of broadband-
enabled health care solutions and technologies are appropriate and
necessary for the FCC to consider with respect to efforts to accelerate
broadband adoption and promote health IT solutions? Are there issues of
concern with respect to access, availability, interoperability,
capacity, reliability, privacy, security, and speed? If so, please
describe them. Does consideration of any of these issues vary depending
on the technology platform--e.g., digital subscriber line (DSL), cable,
fiber, wireless, or satellite?
5. We seek to better understand health care providers' connectivity
requirements. What type of connectivity (e.g., wired or wireless; fixed
or mobile) is necessary to support the deployment of health IT
applications today and in the near future at the different types of
health care delivery settings (e.g., tertiary care centers versus
primary care physician practices, larger physician groups, clinics,
hospitals, as well as ``hospital in the home'' settings).
a. What are the minimum bandwidth and speed requirements for the
different types of health IT applications available today and in the
near future for clinical and non-clinical settings? We also seek
comment on bandwidth constraints brought on by increased overall usage
as well as the impact of data intensive medical applications. Are there
future technologies or applications on the horizon that could be
bandwidth intensive? If so, what are they, and to what extent could
compression and other technologies provide a solution for such future
technologies or applications?
b. Some evidence suggests that real-time image manipulation and
video (e.g., telestroke and tele-emergency applications) will stimulate
demand for more and better broadband and at lower prices. Are there
current issues concerning network speeds and delays for these types of
services? Do mobile health applications present unique considerations
in terms of coverage, reliability, and security? We seek suggestions on
whether, and if so, how the Commission could address these issues.
c. To what extent do rural communities and Tribal lands have access
to Internet connection speeds that are sufficient to support the
effective and efficient transmission of data and video to provide
telehealth, telemedicine, and other broadband health technology
services?
d. What, if any, interoperability, capacity, reliability, security,
and speed issues currently exist for wireless (i.e., radiofrequency
(RF)-based) medical devices used by patients in both clinical and non-
clinical settings (e.g., at home); and for healthcare providers with
respect to the provision of broadband-enabled health technologies, like
telehealth and telemedicine services? Are there other technical issues
appropriate for the Commission to consider?
e. What impediments, if any, exist in trying to retrofit existing
and future health care facilities (e.g., hospitals and clinics) for
broadband-enabled services and technologies, given current connectivity
needs and the existence of varied spectrum environments? Do current
designs take into consideration any potential interference concerns
with projected wireless networks and devices that will be used in these
facilities? Are there (or should there be) industry standards or best
practices for ensuring that new health care facilities consider
broadband in their design and account for any necessary conduits,
wiring, building configuration, and materials (e.g., there may be a
need to consider certain materials for internal or external walls to
better enable wireless broadband within a facility or to limit RF into
a building) at the design and construction phase?
6. We seek to understand the full range of issues that might be
affecting the development and adoption of broadband-enabled technology
and services in health care. What non-technical impediments or issues
currently exist in the provision of broadband-enabled health technology
services? Are there any circumstances or practical considerations
(e.g., cost, funding, and training) that may be creating disincentives
for clinicians and health care settings to offer broadband-enabled
health services and technologies, such as telehealth and telemedicine?
If so, please describe what they are, including the extent and nature
of the Commission's authority to address them.
7. What efforts are being made at the state and local levels to
address broadband health technology accessibility issues in rural and
remote areas, Tribal lands, and underserved urban areas? We seek
specific information, particularly from states, localities, Tribal
governments, and rural and urban medical centers, about any broadband-
enabled health IT programs that have been developed and implemented (or
will soon be implemented) to reach these areas. How successful have
those programs been? What are some of the lessons learned in developing
those programs? What programs and other efforts are necessary to drive
attention to those rural and underserved populations that need health
technologies most? How can the Commission better facilitate the
deployment of services and technologies as well as consumer adoption in
those areas?
8. We seek suggestions on ways the Task Force can effectively and
efficiently identify any gaps in the availability of broadband-enabled
health technologies in the country. We request any information, data,
or studies that
[[Page 21784]]
can better inform the Task Force as to where broadband-enabled health
services and technologies are critically needed in the country but are
insufficient or unavailable. Why do these availability gaps exist? Maps
and data--including those commissioned by or for states or localities--
would be particularly helpful. In August of 2016, the Task Force
launched one such broadband health analytics tool--the Mapping
Broadband Health in America platform--to allow stakeholders to more
easily analyze and study the intersection between connectivity and
health for every state and county in the United States. While the
response to the platform--from other federal agencies, as well as
private organizations and industry--has been uniformly positive, with
some already using the mapping platform to improve data-driven
decision-making around broadband health-related policies and
initiatives, we seek additional stakeholder input. How can we further
improve the analytic platform to encourage investment in broadband
health networks in areas with the greatest health and connectivity
needs? If we wanted to refine the tool to identify potential
partnerships among health care providers or between health care
providers and broadband service providers, what is the best way to
achieve that goal?
9. What are the impediments to making health IT and other broadband
health technology services available and ubiquitous in rural and remote
areas, low population density areas, Tribal lands, and underserved
urban sectors? Are there any unique challenges that persist in these
areas; if so, what are they? In particular, we seek comment on any
deployment, infrastructure, geographic, expertise (e.g., the
availability and adequacy of IT expertise), telecommunications carrier
availability, cost, and any other challenges in these areas. We seek
suggestions for how to address such challenges, including on any rule
and/or policy changes that the Commission should consider.
Objective II: Identify Regulatory Barriers (and Incentives) to the
Deployment of RF-Enabled Advanced Health Care Technologies and Devices
The Commission has a long history of addressing spectrum needs for
the development of next- generation health technologies and medical
devices, and of exercising flexibility, as necessary and appropriate,
in revising its rules and policies to speed up their deployment.
However, in recent months, stakeholders in the health sector and
commercial wireless industry have raised concerns about the likely
surge in demand for spectrum for wireless medical devices and
broadband-enabled services--noting trends toward fully connected
hospitals, widespread remote patient monitoring, and leveraging
connectivity to improve health facilities' workflow and back-office
functions--and have sought appropriate regulatory relief. Most
recently, in August 2016, TerreStar Corporation filed a request for
waiver of its substantial service requirements to enable use of its
wireless licenses in the 1.4 GHz band to provide wireless medical
telemetry service (WMTS) operations, citing increasing demand. Several
wireless medical device manufacturers supported the waiver request and
argued that there was a spectrum shortage facing WMTS licensees.
Below, we seek information and data on (i) the types of broadband-
enabled health technologies and medical devices currently in the market
and those that may be launched in the near future; (ii) the future
spectrum and wireless infrastructure needs in the health care sector;
and (iii) any concerns about the increased use and proliferation of
wireless medical devices in health care settings and public spaces.
Also, we welcome comment on what, if any, regulatory barriers exist (as
well as incentives that could be implemented) concerning the deployment
of advanced broadband-enabled health care technologies and medical
devices. For purposes of this Document, we are only seeking information
on ``medical devices'' that use RF wireless technology or
communications functions for diagnosis, treatment, or patient
monitoring.
10. We seek information on the types of broadband-enabled health
technologies and medical devices that are currently in the market. In
addition, what emerging types of broadband-enabled health technologies
and medical devices are likely to be available to consumers soon? What
are the future trends in this market area?
11. What, if any, technical issues or concerns exist for patients
and other users of medical devices when such devices are used in
hospital settings? Do these concerns vary depending on the type and
size of the hospital setting? Are these concerns exacerbated when
medical devices are operating in large or busy hospital environments
(which may include a wide variety of wireless technologies, some of
which may be unrelated to clinical care); if so, what are those
concerns, how can they be addressed?
12. Similarly, what, if any issues or concerns exist for patients
and other users of medical devices when such devices are used primarily
in potentially uncontrolled, non-hospital settings (e.g., in homes,
aircraft, cruise ships, or other close quarter, multi-unit dwellings,
etc.), where non-health related wireless technologies that also emit
radio frequencies (e.g., baby monitors, wireless home security systems,
Wi-Fi routers, etc.) may proliferate? And to what extent might similar
issues or concerns exist for emerging and future technological
innovations (e.g., electric automobiles, smart cars, smart homes,
etc.)?
13. We seek comment, data, and any studies on the possible
complexities of the future RF environment in homes, hospitals, and
other public spaces related to the increasing number of medical
applications and devices.
14. How are medical devices currently being tested and evaluated to
ensure that consumers and patients can safely use them in both clinical
and non-clinical settings, given their operation in varied spectrum
environments? Are there currently any FCC rules or policies that serve
as barriers to testing and deployment of advanced health care
technologies and medical devices? If any, please identify which
specific rules and/or policies, and explain how they have served to
impede the testing and deployment of health care technologies and
medical devices. How might the Commission address such concerns?
15. We also request recommendations on how the Commission could
make an assessment of the spectrum and wireless infrastructure needs
for the future of health care in the United States. We seek input from
all relevant stakeholders, including members of the health care,
wireless, and software industries who are developing wireless
healthcare applications for the present and future; physicians,
consumer advocates, and academicians; and relevant federal, state, and
local government agencies. While we envision building upon the spectrum
management and wireless infrastructure deployment policies that the FCC
has successfully employed in the past to promote innovation in wireless
health services, we ask commenters to identify any novel framework,
including those that might include smart city initiatives or public/
private partnerships, that could be useful in planning for the wireless
future of our nation's health care system.
a. One of the compelling drivers of mobile technology in healthcare
is the increasing availability of health apps for smartphones and
tablets. There is now
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an app for almost every conceivable healthcare need, ranging from drug
dose calculators to fully functioning electronic medical records. We
are also seeing the development of smart homes and automobiles that
would enable even more sophisticated remote health monitoring. How soon
will we see widespread adoption of these technologies and what
implications will they have on the spectrum needs of the health care
industry?
b. In developing a national spectrum plan for the health care
industry, are there particular spectrum bands that the FCC should
consider?
c. When it comes to increased need for spectrum-based health
technologies, what challenges do small, rural, and critical access
hospitals have that are different from what large hospitals face?
d. Do health care facilities, because of their different physical
characteristics, require different types of small cells and wireless
infrastructure than other commercial enterprises? What are the most
challenging impediments to the deployment of wireless infrastructure in
hospitals and health care systems? What policies should the FCC
consider in order to help streamline infrastructure siting that is
necessary for the deployment of wireless networks in hospitals and
health care systems? What state or local government regulatory policies
have helped to facilitate streamlined deployment of wireless
infrastructure for health care?
e. How can new advanced spectrum sharing techniques (e.g., dynamic
spectrum sharing through database controlled coordination, software
designed radios, or efficient spectrum use through network
virtualization techniques) or secondary market mechanism (e.g.,
spectrum leasing arrangements) be leveraged to meet the spectrum
demands of cutting-edge mobile broadband-enabled health technologies
and medical devices that may be operating in varied spectrum
environments? Are there any issues with harmonization of spectrum for
medical uses across international borders to ensure that consumers can
effectively and safely use medical and other devices across borders?
f. What are some of the recent and emerging trends in health care
delivery (in rural and urban areas) that are implicating spectrum use
and needs? Are these trends creating a greater need for spectrum
wireless services, particularly in rural areas? Are these trends
resulting in increased use of remote patient monitoring solutions?
16. Do any regulatory barriers exist concerning the deployment of
advanced broadband-enabled health care technologies and medical
devices? We also welcome suggestions on any regulatory incentives (that
are within the FCC's authority) that could serve to foster continued
investment in and further deployment of next-generation broadband-
enabled health technologies and medical devices?
Objective III: Strengthen the Nation's Telehealth Infrastructure
Through the FCC's Rural Health Care Program and Other Initiatives
Broadband deployment is one of the FCC's top priorities,
particularly in rural America. Based on current evidence, broadband can
be a game-changer particularly in rural areas--where consumers often
have to drive long distances to access critical or specialty care; and
where isolated clinics and health centers can save lives and promote
community health by using advanced communications technologies to
connect with medical expertise not otherwise available, as well as
monitor patients who live many miles away from a health care facility.
The FCC's Rural Health Care (RHC) Program has helped expand
broadband services for eligible health care providers (HCPs) in rural
areas. Currently, the RHC Program is comprised of three programs: The
Healthcare Connect Fund (HCF), the Telecommunications Program, and the
Pilot Program. With respect to the Pilot Program, while no new funding
is available, some projects continue to accept new HCP sites. As
funding for the Pilot Program projects ends, Pilot Program projects are
expected to apply for additional support, if needed, under the
Healthcare Connect Fund. The FCC established the Healthcare Connect
Fund to expand health care provider access to broadband, especially in
rural areas, and encourage the creation of state and regional broadband
health care networks. Under the Healthcare Connect Fund, eligible rural
HCPs, and those non-rural HCPs that are members of a consortium that
has a majority of rural HCP sites, can receive a 65 percent discount
from the fund on all eligible expenses. HCPs are required to contribute
the remaining 35 percent to participate in the program. HCPs can use
the Healthcare Connect Fund to purchase eligible services and
equipment, as well as construct their own broadband infrastructure
where it is shown to be the most cost effective option. The cap on
total funding for the RHC Program altogether, which includes the
Telecommunications Program and the Healthcare Connect Fund, is $400
million annually.
The Commission's RHC Program has made the benefits of broadband-
enabled health services, such as telehealth and telemedicine, more
available to consumers living in rural and remote areas. Such
broadband-enabled services have provided patients in rural areas with
access to critically needed medical specialists in a variety of
practice areas. The availability of telehealth and telemedicine
programs also has been found to mitigate significant challenges
associated with disparities in access to care and healthcare workforce
shortages. The RHC Program also has been found to save health care
providers money as well. The Commission continues to evaluate the
Healthcare Connect Fund (HCF) in terms of the programmatic goals of (1)
increasing access to broadband for HCPs, particularly those serving
rural areas; (2) fostering the development and deployment of broadband
health care networks; and (3) maximizing the cost-effectiveness of the
program.
17. We seek comment and suggestions on how the FCC can further
promote and help enable the adoption and accessibility of broadband-
enabled health technologies, like telehealth and telemedicine, in rural
and other underserved areas. Are there other initiatives or actions
beyond the RHC Program that the agency, or the Task Force on behalf of
the agency, could pursue in order to promote and help enable the
adoption and availability of broadband-enabled health technologies in
rural and underserved areas of the country?
18. Is the regulatory framework for the Rural Health Care program
keeping pace with how broadband-enabled health care is being delivered
in rural and underserved areas? If not, please explain in detail,
describing any emerging challenges, gaps or opportunities for using
broadband to better meet the health and health care needs of rural
consumers.
19. We seek current information and data, if any, that can be used
to measure the impact that the various RHC programs have had on certain
populations and sectors--i.e., those living in rural and underserved
areas, low density populations, and Tribal lands; older Americans;
persons with disabilities; military veterans; and the economically
disadvantaged in rural and urban communities--all of which have
traditionally faced significant health and health care challenges.
20. We also are interested in hearing recent success stories about
innovative health care services that were created or that became
available as a result of the RHC Program, and how such services
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have helped consumers in rural and remote areas. We are particularly
interested in receiving data and information about health outcomes,
return on investment, and the ability to reach such underserved
population groups. First-person accounts are welcomed.
21. We seek information, data, and studies that identify specific
rural areas and underserved regions of the country that need funding
assistance for the purchase of high-capacity broadband connectivity,
connections, and any other services or equipment authorized under the
RHC Program rules. We seek detailed information and data as to whether
eligible health care providers in these areas and regions that require
funding assistance have participated in the RHC Program, and if not,
why not. We also seek suggestions on how the Commission can encourage
or facilitate their participation. Are there specific challenges of
which the Commission should be aware?
22. The Task Force is interested in identifying all currently
available public (federal, state, or local) and private (e.g., non-
profit or philanthropic organizations) funding sources for the
provision of broadband-enabled health technologies and services (e.g.,
telehealth and telemedicine) in rural regions, Tribal lands, and in
other underserved areas (including underserved urban areas), as well as
for vulnerable populations. Please provide information about those
funding sources, as well as their Web site address, if any.
23. We seek any other comment, information, and data concerning the
RHC Program as well as the general needs of rural consumers for
broadband-enabled health solutions that would be helpful to the Task
Force, given its charge and objectives.
Objective IV: Raise Consumer Awareness About the Value Proposition of
Broadband in the Health Care Sector and its Potential for Addressing
Health Care Disparities
It is critically important that consumers fully understand the
practical and personal benefits of broadband in health care and in
facilitating greater care coordination, proactive engagement in disease
prevention, and self-management. Placing more care decisions in the
hands of consumers and personalizing that experience appears to be a
major theme in health applications and product development today. We
also recognize that as consumers fully realize the practical health
benefits of broadband, consumer demand for broadband-enabled health
services and technologies will serve to further accelerate broadband
deployment and adoption altogether--a national priority.
24. We seek suggestions on how the Commission can effectively
increase consumer awareness about the value proposition of broadband in
the health care sector? Are there any practical efforts that the
Commission can undertake to accelerate consumer adoption of broadband,
and in particular broadband-enabled health services and technologies,
especially among underserved populations? How might the Commission
ensure that certain groups--e.g., rural consumers, those living on
Tribal lands, older Americans, people with disabilities, military
veterans, non-English speakers, and the economically disadvantaged--are
fully aware of the availability and benefits of broadband-enabled
health services and technologies? Are there any states, cities, and
organizations engaged in similar efforts that could lead to potential
partnerships?
25. We also seek comment on any concerns that may discourage
consumers, health care providers, and others from adopting broadband-
enabled health services and other advanced health technologies,
including telehealth and telemedicine services and emerging medical
devices. To what extent do safety, security, reliability, and privacy
concerns influence adoption of broadband-enabled health services and
other advanced technologies? To what extent do costs, socioeconomic
status, and digital literacy issues impact adoption?
26. We request information on any studies, pilots, research, or
other data that quantifies the benefits of broadband-enabled health
technologies in improving patient outcomes and in reducing costs. What
kind of return on investment have pilot and demonstration projects
experienced?
27. We are interested in learning how broadband can enable
healthcare-related support systems to connect patients to the people,
services and information they need to get well and stay healthy. In
this regard, physicians inform us that there is growing recognition
that the need for social services and supports (e.g., nutritionists,
dieticians, pharmacists, family caregivers, fitness centers, and other
health care supports or supporters outside the traditional hospital
setting) significantly impact the ability of some consumers to become
healthy and stay well, and that the availability of broadband is
increasingly essential to bridging the various services and supports.
We seek comment and suggestions on how the Commission can support the
development and availability of these new broadband-enabled services
and supports (outside the RHC Program) especially on Tribal lands and
in rural, remote, and other underserved areas?
28. We seek information and any studies about how broadband-enabled
services and technologies have been, and could be used, to address
health and health care disparity issues, and the impact (and successes)
such services and technologies have had in addressing such issues.
29. Are there any practical issues (e.g., the lack of a home
computer) that may be impeding consumer awareness and adoption of
broadband-enabled health technologies? What efforts can be undertaken
to help alleviate some of these issues?
Objective IV: Enable the Development of Broadband-Enabled Health
Technologies That are Designed to be Fully Accessible to People With
Disabilities
The availability and accessibility of broadband-enabled health
technologies designed to serve the needs of Americans with disabilities
is critically important. One recent study estimates that, in 2013, the
overall percentage of people with a disability in the U.S., among the
civilian noninstitutionalized population, was 12.1 percent or
approximately 37 million people. Other studies suggest that the number
is higher than 50 million, and that it is predicted to continue to
increase. Given these statistics, it is imperative that we do what we
can, within our statutory authority, to promote the goal of making
broadband-enabled health technologies and cutting-edge health and
medical devices and applications available, accessible, and usable by
people with disabilities.
Technology has historically played an important role in the
disability community. Many people with disabilities use communications
technology, devices, or services in their daily lives, and broadband is
becoming an essential data transmission platform that enables a wide
range of services and tools. Ensuring that people with disabilities are
able to access electronic health records, engage in video consultation
with their physicians, fully utilize the latest health apps, and
benefit from advances in wearable health technology, for example, are
essential to the ongoing health care transformation. Consistent with
its charge, the Task Force will consider the extent to which broadband-
enabled services and technologies used for the provision of health and
care are
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available, accessible, and usable by all Americans, including those
with disabilities. We therefore seek any data, information, and comment
that will assist the Commission in better understanding how it may
assist in achieving these important goals.
30. How are broadband-enabled health technologies and medical
devices currently being used by people with disabilities? To what
extent can these technologies and devices address the health care needs
of people with disabilities in the future? Provide specific examples of
the existing barriers, if any, that these technologies and devices pose
for people with disabilities.
31. We seek comment on whether the design and development of
broadband-enabled health services and technologies, as well as cutting-
edge health and medical devices and applications, are accessible to,
and usable by, people with disabilities. Are there practical concerns
or other issues that are inhibiting or limiting the use and
availability of broadband-enabled health services and technologies for
people with disabilities? How are hospitals and clinicians currently
addressing, if at all, any of these issues? An increasing number of
health care services provide patient portals for patients to access
medical records and communicate with physicians and specialists. What
measures are taken to ensure that these mechanisms are fully accessible
to users with disabilities (e.g., accessible via screen readers used by
individuals who are blind)?
32. To what extent are clinicians aware of video relay service
(VRS) and using it when remotely consulting with American Sign Language
(ASL) users on a telephone call? Is there a need for VRS providers to
have ASL interpreters with a knowledge of (and ability to translate)
specialized health or medical vocabulary? Should a VRS call that
involves consultations between a deaf or hard of hearing person and a
doctor be given priority over other calls waiting in a queue,
especially when there is a possible medical emergency? We also seek
comment as to whether our telecommunications relay service (TRS) rules
are currently optimized to encourage medical consults via telemedicine?
33. We seek suggestions as to how the Commission can effectively
raise awareness among people with disabilities about the value
proposition of broadband in health? How can the Commission help to
enable the adoption and accessibility of such services and technologies
among people with disabilities, especially given our authority?
Objective VI: Highlight Effective Telehealth Projects, Broadband-
Enabled Health Technologies, and mHealth Applications Across the
Country and Abroad--To Identify Lessons Learned, Best Practices, and
Regulatory Challenges
Related to the objective of increasing consumer awareness about the
practical health-related benefits of broadband is the need to inform
the public--especially those in rural and underserved regions--about
the availability and successes of the many broadband-enabled telehealth
and telemedicine centers and projects across the country and abroad, as
well as existing and emerging mHealth applications, and to identify
lessons learned and best practices.
34. We seek current information and data on the effectiveness of
broadband-enabled telehealth and telemedicine services, including any
recent research on these services. How are patients responding to these
services? We are particularly interested in receiving comments directly
from consumers about their experience with these and other broadband-
enabled services and technologies.
35. We also seek comment on specific challenges faced by states,
localities, and Tribal governments, as well as communities abroad, in
deploying effective broadband-enabled telehealth and telemedicine
projects.
36. We seek comment on how the public can be better informed about
the availability of broadband-enabled health services and technologies
and mHealth applications. What have states, localities, other federal
agencies, Tribal governments, and hospitals and clinics done to inform
the public about the availability of these options? How effective have
these projects been in promoting greater broadband utilization?
37. We seek submissions of any case studies, research and video/
audio summaries concerning recently launched applications/programs that
are on the cutting edge of telehealth, telemedicine, mHealth, and other
broadband-enabled health technologies and services.
38. We seek comment on the extent to which the United States is not
taking full advantage of the opportunities that broadband-enabled
health technology provides. For countries that have been the most
successful in making broadband-enabled health services and technology
more widely available, especially in rural and underserved areas, we
seek information on the approaches that such countries took (including
lessons learned) in achieving success in broadband health adoption.
Objective VII: Engage a Diverse Array of Traditional and Non-
Traditional Stakeholders To Identify Emerging Issues and Opportunities
in the Broadband Health Space
Published reports indicate that the ``the health IT industry is
gaining a reputation as an emerging sweet spot for technology
investors.'' We want to be sure that Commission policies do not present
obstacles to continued innovation and investment in broadband-enabled
health technologies, including medical devices that rely on
communications technology. We observe that there is a growing desire
for such technologies--including those that are wearable or otherwise
track and monitor personal health--and that this emerging health market
is estimated to be worth billions. There are also countless smartphone
apps that track health-related issues. By some estimates, there are
over 100,000 digital health apps offered in the three major app stores.
In addition, recent advances in broadband-enabled sensor technology
offer the potential for the emergence of more convenient and ultimately
less costly and less invasive health care solutions. For example, we
may soon see the widespread use of smart clothing (or smart ``tattoo''
applications) that use skin-based sensors to measure things like heart
rate, respiration, and blood pressure. Robotics, virtual reality, and
other consumer facing health technologies also offer the potential to
help older Americans live more independently. Some technology companies
are even experimenting with combining web search with online health
consultations for a one-stop offering. To help inform the Commission in
its related and other efforts in this area, we seek comment and
information on these and other emerging health technologies,
applications, services, and connected medical devices.
39. We seek comment on any emerging issues of concern (that have
not been identified in this Document) that potentially impact efforts
to accelerate the availability of broadband-enabled health technologies
and services, as well as medical devices that rely on communications
technology.
40. While the United States has made great strides in recent years,
many advances in digital health technologies are still not broadly
available, widely utilized, or well-tailored to meet the
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needs of all Americans. We seek comment on these concerns.
41. What are the emerging opportunities for investors, innovators,
and entrepreneurs in the broadband health space and in the development
of the next generation of connected health technologies and converged
medical devices? We seek suggestions on any efforts that the Commission
might undertake to support innovation and entrepreneurship in these
areas. Are there emerging or non-traditional stakeholders that should
be part of the Commission's efforts? If so, please identify them and
their respective roles in or contributions to the broadband health
space.
42. We seek comment on how to promote small and diverse investors,
innovators, and entrepreneurs in the broadband health sector in order
to better ensure that the benefits of broadband-health technologies and
services are available to all Americans.
43. We seek to engage all potential stakeholders in this national
broadband health effort. Commenters should identify any additional
stakeholders that are not specifically referenced in this Document. We
also encourage parties to identify any other relevant issues (not
covered in this Notice) for the Task Force, given its charge and
objectives.
Administrative Matters. Because this Document does not itself
initiate a ``proceeding,'' responses to the Document are not
``presentations'' subject to the prohibitions in restricted proceedings
and the disclosure requirements in permit-but-disclose proceedings.
Nonetheless, parties discussing or providing information to the Task
Force or any other members of the Commission regarding the issues
raised in this Document are strongly encouraged to file a memorandum in
the docket, summarizing their discussion and/or information.
Federal Communications Commission.
Marlene H. Dortch,
Secretary.
[FR Doc. 2017-09309 Filed 5-9-17; 8:45 am]
BILLING CODE 6712-01-P