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FCC Healthcare and m. Health Initiatives Do. D/VA m. Health Nov 18, 2013 Matt FCC Healthcare and m. Health Initiatives Do. D/VA m. Health Nov 18, 2013 Matt Quinn, Director of Healthcare Initiatives Federal Communications Commission (FCC)

Agenda • About FCC and its Role in Healthcare • Rural Healthcare Program • Agenda • About FCC and its Role in Healthcare • Rural Healthcare Program • Regulatory Domain • Spectrum for Medical Devices • Equipment Authorization • MBANs • FCC-FDA Cooperation • Wireless Test beds and Experimental Licensing

Federal Communications Commission Mission Staff & Offices • Approx. 1700 Attorneys, Engineers, The FCC Federal Communications Commission Mission Staff & Offices • Approx. 1700 Attorneys, Engineers, The FCC was established by the Communications Act of 1934 and is charged with regulating interstate Economists, et al and international communications by radio, • HQ at 445 12 th St, SW, Wash. , DC television, wire, satellite and cable. The FCC's • Lab in Columbia, MD jurisdiction covers the 50 states, the District of • Field Offices: 3 Regional, 16 District, Columbia, and U. S. possessions. 8 Resident Agent www. fcc. gov

FCC Areas of Responsibility • Rural Health Care Program: Supports broadband for health care FCC Areas of Responsibility • Rural Health Care Program: Supports broadband for health care providers, which promotes telemedicine adoption to expand patient access to specialists and drive down costs. • Broadband: Advances both wireline and wireless communications services and technologies, thus enabling many medical and medical-associated applications. • Spectrum: Provides access to the airwaves for wireless medical devices and various radio services that support Health IT applications, while preventing harmful interference. • National Broadband Plan: Engages in a variety of actions and activities to facilitate Health IT under NBP recommendations. 4

The Promise of Broadband-Enabled Health Technology Expanding connectivity for health technology can: Increase access The Promise of Broadband-Enabled Health Technology Expanding connectivity for health technology can: Increase access to health care and medical expertise, especially in hard to serve areas – Telemedicine and video conferencing allow rural health care providers to take advantage of specialists, training, and resources in urban centers Improve patient care by utilizing data to improve health care strategies – Patients who used a mobile tracking system for diabetes care received regular, tailored self-care messages and were able to achieve significant reduction in blood sugar levels over a year long study Reduce health care costs by using information to improve efficiency of care delivery – Telehealth can reduce the costs of medical care among the elderly by 25%, because it reduces the number of face to-face consultations needed – Costs related to data collection can be reduced by allowing patients and doctors to access health records remotely, increase efficiency, avoid duplication, and save between 20% and 30% in administrative costs 5

As a platform for innovation and information exchange, broadband can help improve health outcomes As a platform for innovation and information exchange, broadband can help improve health outcomes and lower the cost of care 1 3 2 4 Drive innovative applications and advanced analytics Create incentives for broader health IT adoption and innovation Modernize regulations to increase access to care and enable health IT adoption • Increase e-care pilots that evaluate cost savings & clinical outcomes • Revise credentialing, privileging and state licensing requirements to enable e-care • Create next-generation interoperability across clinical, research and administrative data • Clarify regulatory requirements and the approval process for converged communications and healthcare devices • Ensure patients have access to and control over their health data • Expand reimbursement for ecare under current fee-forservice model where outcomes are proven • Provide Congress with a plan to realize the value of e-care Ensure all providers have access to affordable broadband • Transform the Rural Health Care Program - Subsidize ongoing costs - Subsidize network deployment - Expand eligibility - Require institutions to meet outcomes-based measures • Upgrade Indian Health Service broadband service • Track and publish progress on broadband connectivity in healthcare facilities 6

m. Health Task Force • Task Force sparked via FCC held m. Health Summit m. Health Task Force • Task Force sparked via FCC held m. Health Summit (June 2012) bringing together academia, industry, and government to accelerate adoption of wireless health technologies. – Participants included senior executives and leaders from health technology companies, including established companies, startups, non-profits, hospital leaders, and government experts – The Co-chairs of this working group were Julian Goldman from Partners Health. Care, Robert Jarrin from Qualcomm, and Douglas Trauner from Health Analytic Services. • In September 2012, the m. Health Task Force released its report and recommendations to the public. – The Report set the following five year goal: For m. Health technology to become a routine medical best practice within five years.

m. Health Task Force • The FCC has taken action on 85% of the m. Health Task Force • The FCC has taken action on 85% of the m. Health Task Force recommendations, including: q q q q Enable wireless test beds Create the Health Care Connect Fund Broadband Adoption Lifeline Pilot Promote international spectrum usage for MBANs Enhance FCC coordination with CMS Hired Director of Health Care Initiatives Improve interagency alignment, data sharing, and cooperation Launch FCC. gov/health 8

Director of Healthcare Initiatives • A new position to coordinate the FCC’s numerous initiatives Director of Healthcare Initiatives • A new position to coordinate the FCC’s numerous initiatives related to expanding access to healthcare applications through wired and wireless broadband • Lead the agency’s efforts in promoting communications technologies and services that: – Improve the quality of health care for all citizens and help reduce health care costs; – Facilitating the availability of medical devices that use spectrum; – Ensuring hospitals and other health care facilities have required connectivity • Collaboration, coordination, communication

Current FCC Rural Health Care Programs • Telecommunications Program – Funds urban/rural rate difference Current FCC Rural Health Care Programs • Telecommunications Program – Funds urban/rural rate difference for telecommunications services for rural HCPs – Remains in place after Healthcare Connect Fund is implemented • Internet Access Program – Provides 25 percent discount on Internet access services for rural HCPs – Ends June 30, 2014, as participants transition to Healthcare Connect Fund • Pilot Program – Supports 50 state-wide and regional broadband HCP networks – Participants transition to Healthcare Connect Fund as Pilot funds are exhausted 10

Key Features of New Healthcare Connect Fund • Support for broadband connectivity and broadband Key Features of New Healthcare Connect Fund • Support for broadband connectivity and broadband networks for eligible health care providers (HCPs) • Both consortium and individual HCPs may apply • 35% HCP contribution required • Funding begins January 1, 2014 (July 1, 2013, for existing Pilot projects) • Covers both broadband services and HCP-owned infrastructure • Non-rural HCPs can participate if in majority-rural consortia • Multi-year funding commitments available to consortia • Connections to off-site administrative offices and data centers covered 11 11

Benefits of Consortium Approach • Creation and growth of broadband HCP networks • Lower Benefits of Consortium Approach • Creation and growth of broadband HCP networks • Lower administrative costs • Sharing of medical, administrative, and technical expertise • Lower prices, higher bandwidth, and better quality connections • Access by rural HCPs to medical specialists at larger HCPs through telemedicine • Enhanced exchange of electronic health records and coordination of patient care • Remote training of medical personnel • Improved quality and lower cost of health care 12

Who is eligible to participate? • To be eligible, an HCP must be public Who is eligible to participate? • To be eligible, an HCP must be public or not-for-profit and belong to one of these statutory categories: hospitals, rural health clinics, community health centers, health centers serving migrants, community mental health centers, local health departments or agencies, postsecondary educational institutions/teaching hospitals/medical schools, or a consortia of the above. 47 U. S. C. § 254(h)(7)(B) • Non-rural HCPs may participate in Healthcare Connect Fund if they belong to a consortium that has a majority rural HCPs • The largest HCPs (400 + patient beds) are eligible, but support is capped if non-rural. 13

What is supported? • For all applicants: – – Broadband services Reasonable and customary What is supported? • For all applicants: – – Broadband services Reasonable and customary installation charges Equipment necessary to make service functional Connections to off-site administrative offices and data centers – Connections to research & education networks • Consortium applicants also may receive support for: – Equipment necessary for network – Upfront charges for deployment of new or upgraded facilities, including dark fiber HCP constructed and owned facilities, if shown to be most cost-effective option 14

Application Process – Usual Steps • Assess technical requirements • Organize consortium and design Application Process – Usual Steps • Assess technical requirements • Organize consortium and design network (consortia) • Obtain and submit letters of agency and network plan (consortia) • Submit request for services (or RFP) for competitive bidding (unless exempt from competitive bidding) • Review bids and select most cost-effective bid • Submit request for funding commitment • Begin receiving services • Receive vendor invoice and pay HCP portion (35 %) • Submit invoice for payment by Administrator to vendor 15

Skilled Nursing Facilities Pilot Program • Purpose is to test how to support broadband Skilled Nursing Facilities Pilot Program • Purpose is to test how to support broadband connections for skilled nursing facilities • Pilot will get underway in 2014 • Funding will be up to $50 million total over a three-year period • FCC will solicit input regarding design of the pilot program • Participants will be required to collect data and submit reports 16

Funding Caps • Cap on total funding for FCC Rural Health Care Programs, including Funding Caps • Cap on total funding for FCC Rural Health Care Programs, including Healthcare Connect Fund and Skilled Nursing Facilities Pilot, is $400 million annually • Cap for upfront payments in Healthcare Connect Fund is $150 million annually 17

Questions? For more information: – Healthcare Connect Fund order, at http: //hraunfoss. fcc. gov/edocs_public/attachmatch/FCC-12 Questions? For more information: – Healthcare Connect Fund order, at http: //hraunfoss. fcc. gov/edocs_public/attachmatch/FCC-12 -150 A 1. doc – FCC website, http: //www. fcc. gov/encyclopedia/rural-health-care – Healthcare Connect Fund FAQs, http: //www. fcc. gov/encyclopedia/healthcare-connect-fund-frequently-askedquestions – USAC website, www. usac. org/rhc – Pilot Program map, http: //www. fcc. gov/maps/rural-health-care-pilot-program – Pilot Program Staff Evaluation, http: //hraunfoss. fcc. gov/edocs_public/attachmatch/DA-12 -1332 A 1. pdf – Questions: [email protected] org 18

FCC as Enabler of Wireless Technologies in Medical Care + = FCC as Enabler of Wireless Technologies in Medical Care + =

FCC Regulations • Federal Communications Commission (FCC) manages use of the radio spectrum by FCC Regulations • Federal Communications Commission (FCC) manages use of the radio spectrum by the private sector: – First, the Commission establishes technical regulations (frequency allocation, emission, etc. ) for transmitters and other equipment to minimize their potential for causing interference to radio services. – Second, the Commission administers an authorization program to ensure that equipment reaching the market complies with the technical requirements. (Part 2 J)

Broadband for Medical Applications Cellular, PCS, AWS Bands Hungry Devices Consumer Apps National Purposes Broadband for Medical Applications Cellular, PCS, AWS Bands Hungry Devices Consumer Apps National Purposes Civic Engagement Telemedicine Public Safety Smart Grid 21

Spectrum for Medical Devices Medical Radiocommunications Service Implants and Body Worn MMNs MBANs 00 Spectrum for Medical Devices Medical Radiocommunications Service Implants and Body Worn MMNs MBANs 00 24 60 23 7 45 1 45 4 44 8 43 2 43 6 42 9 41 3 41 6 40 1 40 Wireless Medical Telemetry Service UHF-TV WMTS UHF-TV 32 27 14 14 00 14 95 13 4 8 61 60 0 47 ISM & UNII Bands (Unlicensed Devices) Indoor Only DFS 5 2 58 5 2 57 0 7 54 0 5 53 0 5 52 0 5 51 3. 5 8 24 0 0 24 8 92 2 90 22

Unlicensed Devices • Many medical devices operate under rules for unlicensed devices – Part Unlicensed Devices • Many medical devices operate under rules for unlicensed devices – Part 15 – Unlicensed devices • Low power • No interference protection – Part 18 – Industrial, Scientific, Medical devices • Interference protection within ISM allocated frequency bands – Examples • Assistive listening devices • Boston Scientific - Implantable pacemakers, cardioverter defibrillators and cardiac resynchronization therapy devices that use inductive coupling – Currently use 90 -110 k. Hz, but moving to 902 -928 MHz • Enteromedics – Implantable devices to treat gastro-intestinal disorders – Uses 6. 765‑ 6. 795 MHz ISM band • Second Sight - Retinal Prosthesis System – Power transmission on 3. 156 MHz (ISM) / Data on 481. 5 k. Hz (Part 15) – Healthcare institutions also extensively use wi-fi, bluetooth, zigbee and RFID 23

Equipment Authorization Required • Multi-tiered equipment authorization program - - many devices self-declared • Equipment Authorization Required • Multi-tiered equipment authorization program - - many devices self-declared • Most transmitters must be certificated by FCC or telecommunications certification body • Equipment may not be imported or marketed until certificated • Check label for FCC ID • Grants of certification available on FCC web site See http: //www. fcc. gov/oet/ea/ FCC Id: XXXYYYY

Wireless Medical Devices and Applications are Emerging 25 Source: Air. Strip Technologies, Intel, Medtronic, Wireless Medical Devices and Applications are Emerging 25 Source: Air. Strip Technologies, Intel, Medtronic, Cardio. Net, Corventis

What is an MBAN? • A Medical Body Area Network (MBAN) consists of body-worn What is an MBAN? • A Medical Body Area Network (MBAN) consists of body-worn sensors placed on a patient in order to monitor physiological data (such as heart rate, respiration, and blood pressure) and perform diagnostic and therapeutic functions, that, in turn, are wirelessly linked to a nearby external control unit. – The control unit aggregates the data and then sends it to a monitoring point (such as to a nurse’s station) via existing or readily available communication infrastructure (Ethernet, Wi. Fi, Wireless Medical Telemetry Service, etc. ). – Primary application is in a health care facility but we anticipate other opportunities for use – even at a patient’s residence.

Recent FCC Actions • Retinal Implants, November 2011: OET granted a waiver to Second Recent FCC Actions • Retinal Implants, November 2011: OET granted a waiver to Second Sight Medical Products, Inc. of Section 15. 209(a) of the Commission’s rules to allow it to obtain FCC certification for and market its Argus II Retinal Prosthesis System which is a medical implant system designed to treat profoundly blind people. n Medical Body Area Networks (MBANs), May 2012: Order to allocate spectrum for Medical Body Area Networks, making the U. S. the first country in the world to make spectrum available for this specific usage. MBANs are networks of wireless sensors which transmit data on a patient’s vital health indicators to their doctor or hospital. Experimental Licensing Order, January 2013: Order to promote expanded opportunities for radio experimentation and market trials, including for medical devices n 27

Medical Body Area Networks (MBANs) • Commission adopted rules in May, 2012 allowing MBANS Medical Body Area Networks (MBANs) • Commission adopted rules in May, 2012 allowing MBANS to share 2360 – 2400 MHz with aeronautical telemetry and amateurs – Based largely on joint industry agreement and coordination • Very short-range networks of multiple body-worn sensors (e. g. , chest, back, arms, etc. ) and a nearby hub station: – Sensors take readings of key patient-specific information (e. g. , temperature, pulse, blood glucose level, etc. ) – Antennas embedded in sensors wirelessly transmit data to body-worn or closely located hub devices – Hub devices may process data locally and/or transmit it wirelessly for centralized processing, display, and storage • MBANS can reduce infection risk, increase patient mobility & improve caregiver effectiveness 28

FCC – FDA Cooperation • FCC and FDA have worked together for many years: FCC – FDA Cooperation • FCC and FDA have worked together for many years: – FCC: Office of Engineering and Technology and Wireless Telecommunications Bureau – FDA: Center for Devices and Radiological Health – Meet regularly to discuss topics of mutual interest • Past and ongoing topics: – – – – • Managing interference to telemetry systems from DTV Managing transition of telemetry in 450 MHz band Identifying new spectrum for telemetry systems Electromagnetic Compatibility (EMC) Hearing aid compatibility of wireless phones Radio frequency Exposure FDASIA Ongoing consultation among FCC and FDA staff: – Guidance for wireless medical apps – Guidance for EMC – Guidance for RF safety 29

FCC-FDA Joint Public Meeting - July 26, 2010 • First-Ever Agency Partnership to Improve FCC-FDA Joint Public Meeting - July 26, 2010 • First-Ever Agency Partnership to Improve Health Care Quality, Reduce Costs, Spur Private Investment – Agencies entered into MOU • Agencies agree to work together to promote initiatives related to the review and use of FDA-regulated medical devices that utilize radiofrequency emissions – Goals • Further enhance information sharing efforts in order to further ensure the safety and efficacy of medical devices • Improve the efficiency of the agencies’ regulatory processes in areas where their jurisdiction overlaps, such as with respect to various medical devices that utilize broadband wireless technology • Promote efficient utilization of tools and expertise for product analysis, validation, and risk identification • Build infrastructure and processes that meet the common needs for evaluating broadband wireless enabled medical devices 30

Recent FDA Final Guidance on Wireless Medical Devices (Aug 13, 2013) • Radio Frequency Recent FDA Final Guidance on Wireless Medical Devices (Aug 13, 2013) • Radio Frequency Wireless Technology in Medical Devices - Guidance for Industry and Food and Drug Administration Staff • Addresses considerations that may affect the safe and effective use of medical devices that incorporate RF wireless technology (wireless medical devices), including: – Selection of wireless technology, quality of service, coexistence, security, and EMC. • Such RF wireless technologies operate under a grant of certification and/or issuance of a license from the Federal Communications Commission (FCC). http: //www. fda. gov/Medical. Devices/Device. Regulationand. Guidance/Guidance. Documents/ucm 077210. htm

Wireless Test beds – Experimental License Program • FCC has adopted (January 31, 2013) Wireless Test beds – Experimental License Program • FCC has adopted (January 31, 2013) new Experimental Licensing rules to expand existing Experimental Radio Service rules to promote cutting-edge research and foster development of new wireless technologies. • Through a “medical testing license, ” qualified healthcare facilities would have broad authority to conduct research without the need to seek new approval for each individual experiment. • This will help facilities, and industry more broadly, better evaluate how wireless technologies and other electronic devices coexist in a hospital environment. – For example, how might a medical body area network react with others sensitive medical monitoring equipment, such as infusion pumps or fetal monitoring devices? – How might it affect diagnostic equipment in the OR and vice versa? – What happens when multiple patients in a waiting room are being simultaneously monitored by MBANS?

Thank You! Matt Quinn Director of Healthcare Initiatives Federal Communications Commission (FCC) Email: matthew. Thank You! Matt Quinn Director of Healthcare Initiatives Federal Communications Commission (FCC) Email: matthew. [email protected] gov