FCC Works to Ensure Rural Providers Realize Telemedicine Benefits

All dressed up with nowhere to go.

With the healthcare industry’s rapid movement toward broad implementation of electronic health records and utilization of wireless-enabled medical devices, it’s easy to overlook the fact that many providers around the country still don’t have access to adequate broadband connectivity. As Kerry McDermott, an expert advisor to the National Broadband Task Force, pointed out, a rural clinic can take as many x-rays as they want, but if no one sees them, they don’t do the local providers or patient much good.

This summer the Federal Communications Commission proposed a new healthcare connectivity program. Tentatively called the U.S. Health Connect and Rural E-care Fund, the proposal is based on recommendations in the agency’s National Broadband Plan (NBP) and would help ensure medically underserved communities have a seat at the HIT table. The FCC estimates nearly 30 percent of federally funded rural healthcare clinics cannot afford or do not have access to secure, reliable broadband services. Without this access, providers are not able to provide even the most basic of telehealth tasks such as implementing and managing an EHR, transmitting diagnostic images or consulting remotely with specialists in urban settings.

The proposal would make the FCC’s Rural Health Pilot Program permanent with many modifications. Following up on another recommendation in the NBP, the FCC recently partnered with the Food and Drug Administration to work together to promote initiatives related to the review and use of FDA-regulated medical devices that utilize radiofrequency emissions or that would otherwise fall under the jurisdiction of the FCC. The NBP found the use of communications devices and networks in the provision of healthcare is increasingly transforming medicine by allowing physicians and other providers to treat patients anywhere at any time of day while cutting cost and improving quality. However, these devices progressively rely on commercial wireless networks to relay information.

Working with the FDA is one example of what has become an increasingly important role for the FCC in the field of telehealth. Phoebe Yang, senior advisor to the chairman on Broadband, noted the FCC is stepping up to serve as an expert resource in the engagement and coordination across federal agencies of the implementation of the NBP’s recommendations.

Of course, a huge focus for the FCC has been addressing the connectivity challenge. Yang said the FCC launched the Rural Health Care Pilot Program in 2007 making up to $400 million in universal service funding available over three years to support broadband infrastructure deployment in areas where the greatest need for telemedicine exists.

Based on the outcomes of the pilot project, which is scheduled to expire next year, the FCC is recommending support for broadband infrastructure become permanent so that more qualified applicants could take advantage of available financial support. “With connectivity, there are two problems — either the infrastructure is missing, or it’s too expensive,” Yang said.

To address these issues, she said the FCC identified three essential goals: to create a permanent broadband infrastructure fund, create a broadband services fund at the provider level and to increase the eligible providers by 20 percent.

“The goal is to provide 85 percent support with a 15 percent participant match to cover the construction costs for new or upgraded broadband networks,” she said of building the infrastructure. Yang added that the FCC has also recommended the current financial support available for recurring monthly usage fees be increased from 25 percent to 50 percent to help make access more affordable to public and nonprofit healthcare providers. The third goal is to increase eligibility by extending benefits to facilities that perform some of the same functions as hospitals, such as qualified skilled nursing facilities, renal dialysis centers and off-site administrative offices and data centers that provide support functions for the health networks.

“Basically, we want to make the program more robust than it has been in the pilot,” she said. Yang noted the FCC is currently going through comments received from the recent Notice of Proposed Rulemaking on the subject as the agency considers transforming existing Rural Health Care programs into the new U.S. Health Connect and Rural E-care Fund.

Of equal importance going forward is the need to embrace the promise of wireless medical devices. “We really need to provide clarity where wireless meets medical,” said Kerry McDermott, who was an author on the healthcare chapter of the NBP. “Our goal is to promote innovation and investment in wireless devices while protecting patient safety,” she stated. McDermott added that what has been learned through crafting the NBP is that the healthcare industry really operates in an outmoded manner at this point.

The memorandum of understanding that was executed between the FCC and FDA in late July clears the way for the two federal agencies to work hand-in-hand to bring innovative wireless devices to the industry, while maintaining a watchful eye on safety and efficacy. “Not only will cutting-edge devices improve medical care and reduce health costs, they will catalyze private investment to create jobs and spur economic growth,” FCC Chairman Julius Genachowski said at the announcement of the partnership.

In order to effectively make use of such devices, however, it’s important that bandwidths support larger and larger digital files in a timely manner. McDermott said that once needs are assessed, the next step is to see what the pipeline serving the rural facility could handle. If the pipeline falls short, then a connectivity gap exists and must be addressed.

Both Yang and McDermott stressed the benefits of a wired healthcare system that would allow rural providers access to state-of-the-art devices and real-time specialist consultations that previously were only available in large, urban markets. Building a robust infrastructure now should afford rural providers the opportunity to rapidly deploy new technology as it becomes available.

“We’re trying to future-proof our healthcare delivery system,” McDermott concluded.

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