National Broadband Plan Workshop (Health Care)

Federal Communications Commission
Room TW-C305 (Commission Meeting Room)
445 12th Street SW
Washington, DC 20554

September 15, 2009

Tom Buckley
[email protected]
(202) 418-0725

The goal of this workshop is to gather information concerning how and where broadband networks are deployed to provide telehealth services throughout the nation. Specifically, we will identify both the types of health care facilities and areas that have adequate connectivity to telemedicine broadband networks and where connectivity remains lacking. In addition, workshop participants will be encouraged to provide examples of successful telehealth programs and will be asked to identify whether telehealth diagnosis and treatment is covered under medical insurance. Finally, there will be a public safety component of the workshop seeking information how to ensure secure access to electronic medical records and coordination between federal, regional, and local emergency responders, particularly during public health emergencies, disasters or other large-scale events. Information and data obtained in this workshop will enhance the Commission's understanding of the barriers facing the health care community in accessing broadband telehealth connectivity as the Commission develops the National Broadband Plan.

FCC Participants:

  • Erik Garr, General Manager, Omnibus Broadband Initiative, Office of Strategic Planning and Policy Analysis (OSP)
  • Dr. Mohit Kaushal, Director of Healthcare, Omnibus Broadband Initiative, OSP
  • Ernesto Beckford, Attorney Advisor, Telecommunications Access Policy Division, WCB

Panel 1: Connectivity

  • Douglas Van Houweling, President & CEO, Internet2
  • Scot J. Eberle, CEO, FiberUtilities Group LLC
  • Dale Alverson, Professor of Pediatrics & Regents' Professor, University of New Mexico School of Medicine
  • John Clarey, Chairman, National Medical Wireless Broadband Alliance
  • Raju Prasannappa, Chief Technologist, Harris Healthcare Solutions


Panel 2: Investment and Usage

  • Aneesh Chopra, Assistant to the President & Chief Technology Officer, Office of Science and Technology Policy, Executive Office of the President
  • Dr. Kaveh Safavi, MD, JD, Vice President & Global Lead Health Practice, Internet Business Solutions Group - Healthcare, Cisco
  • Protima Advani, Practice Manager, IT Insights Program, Advisory Board Company
  • Dr. Karen Rheuban, MD, Senior Associate Dean for CME & External Affairs Medical Director, Office of Telemedicine, University of Virginia; President, American Telemedicine Association
  • Nina M. Antoniotti, R.N., M.B.A., Ph.D., Program Director, Marshfield Clinic TeleHealth Network

The following are some of the preliminary topics that will be covered at this workshop. The FCC is inviting suggestions.

  • What benefits can broadband bring to healthcare providers? To patients?
  • Do facilities in the health care industry have adequate access to broadband?
    • Are there particular types of health care facilities that are more likely to lack adequate access to broadband, and if so, what are those types? Why are they likely to lack adequate access?
    • Do different types of health care facilities require different connectivity speeds or have different infrastructure needs? What are the differences?
    • Are there particular areas of the country where health care facilities are more likely to lack adequate access to broadband? What are the causes of such inadequate access?
  • In what ways has the universal service Rural Health Care Program, including the Rural Health Care Pilot Program, increased broadband access to health facilities?
  • Have recipients of such funding altered the way they have delivered medical services or the medical services they provide?
  • To what extent do health insurance plans currently cover telemedicine diagnoses and treatments?
  • How can broadband facilitate efficient, effective, and secure access to medical records? To the extent that greater safeguards are required, how can they be developed and implemented?
  • What benefits can broadband bring to federal, regional, and local emergency responders? Do they have the connectivity and coordination they need, and if not, where and why not?
  • What is the cost of deploying additional broadband infrastructure to these areas, facilities, and responders?

Here's a look at what some are already telling the FCC...

Rural Health Pilot Program Group of Internet2
We propose that the following goals should be championed by the Administration:

  • To improve access to health care in urban and non-urban areas by leveraging the speed and connectivity of broadband telecommunications.
  • To allow and encourage urban safety net and for-profit health care providers and institutions to participate in the rural broadband network to help achieve universal healthcare quality.
  • To use broadband connectivity to:
    • Provide access to specialty care as well as specialized health care resources and expertise;
    • Encourage and enable collaboration among medical centers and community-based safety net providers;
    • Provide better educational opportunities for rural physicians;
    • Facilitate participation in research activities, such as clinical trials.

National Organization Of State Offices Of Rural Health

1. The National Broadband plan must address the question, "Does rural matter? If so, then we can start to create a broadband model that is needed - one that addresses issues of equity, empowerment and capacity building. The basis of our present system was a push for a public benefit that was shared by all. Without an accessible broadband base, rural entrepreneurs cannot compete. Capacity building is key, the nation is not able to use all of its human capacity without accessible, affordable broadband.

2. The FCC must build the plan with an eye to the new "green world" that we are in. Rural America is the new frontier for energy, environment, food and medicine production. These big issues all demand big broadband resources in the name of public good.

3. The FCC should engage State Offices of Rural Health in order to engage the wide perspective of rural communities, healthcare providers and facilities in the development of the plan.

4. The FCC should consider revamping the past REA model that brought electricity to rural America. That push to equalize opportunity made a huge difference in the productivity and
quality of life for rural Americans.

5. The FCC should work with other federal agencies to ensure that we have the right training programs that guarantee that the technology will be used readily.

6. The FCC should ensure planning reviews issues relating to reimbursement of related costs
needed to install and implement broadband infrastructure in rural America. This should include
costs of software and hardware tied to broadband utilization in rural areas. Health care, education and training need this support.

7. The FCC should ensure planning that investigates the feasibility to collect taxes from all modes of communication to ensure that a sustainable telecom model can be built and sustained. Cell phones, etc. should no longer be exempt.

8. The FCC should collaborate with other federal agencies to create a unified strategic broadband plan through which each agency could implement their individual programs. We must think organically, not linear, on these issues.

9. The plan should review current cost policies for grants/loans from the Rural Utilities Service.
Currently, funding can only be used to implement technology infrastructure. Future funding
should also support personnel and training costs associated with implementing such

Michigan Public Health Institute
If our nation is going to realize the benefits of interoperable health IT, health care facilities are going to require not only high‐speed but also extremely reliable connections. As more and more health information moves to an electronic format, connectivity is becoming vital. As health care continues to evolve at an unprecedented pace, it would be difficult to overestimate bandwidth needs. However, it is clear that health care organizations will need more bandwidth than a typical business of similar size; furthermore, due to the nature of the business, that bandwidth must always be available. Connections to hospitals and other emergency providers must approach "five nines" availability with an average uptime of 99.999%. This far exceeds the typical service level that ISPs provide and can require multiple, redundant connections. These connections must remain available in all weather, even in cases of natural or man‐made disasters. Recent events have shown that emergency and public health providers need more bandwidth, not less, in cases of disasters, particularly in pandemic or bio/chemical terrorist events, as the need to share information during these times are vital to public health.

University of Arkansas Medical Services

  • First - FCC must ensure that broadband access and support is available to hospitals and doctors across the state.
  • Second Broadband must be affordable - The recurring monthly service charge is not the only affordability barrier, but significant limitations are seen in the one-time, initial cost Of acquiring equipment necessary to participate in telemedicine services. UAMS urges the FCC to consider these limitations, especially in small hospitals and clinics found throughout rural ares, as the cost of line charges and one-time purchases of equipment limit many end users who could possibly benefit from broadband-driven telemedicine services the most.
  • Finally, as a recipient of the Rural Health Care Pilot Program, the FCC must make sure provisions in the NBP do not stifle new tech developments.

    Erik Nyberg
    As an health care IT leader, when I look at what prevents me from creating efficiency, coordinating activities, and using IT to improve the quality of care, affordable bandwidth is BY FAR my biggest limitation. Affordable 50MB+ connections everywhere will hugely improve this country in every way imaginable. The existing telephone companies have NO interest in doing this for us. Working with them is one of the worst parts of my job.

    National Spinal Cord Injury Association
    As we all know the maximum benefits of broadband Internet will not be realized until every American has the access, equipment, and skills necessary to connect to and navigate the Internet. In order to provide for these needs the FCC's national broadband plan should call for new programs. For instance, programs that encourage broadband providers to continue investing and building out their networks in rural areas would enable previously unserved users to connect. Cost is a major barrier to broadband access for many of our constituents. Programs subsidizing equipment and connection expenses (similar to the USF) will enable those of modest means to access broadband Internet. Finally, programs designed to educate prospective broadband Internet users should be implemented so they can more quickly realize the benefits. Each of these programs should be tailored to meet the needs of various groups of people, including those living with the results of spinal cord injury and disease by incorporating messages about access in widely distributed communications as well as creating communications targeted directly at the disability community, those who provide support services, and healthcare professionals. Above all, the FCC should advocate a path for continued private investment so these realities can be achieved.

    And may we suggest...

    the Health Care chapter from Benton's Action Plan for America: Using Technology and Innovation to Address Our Nation's Critical Challenges.