82 FR 21780 - FCC Seeks Comment and Data on Actions To Accelerate Adoption and Accessibility of Broadband-Enabled Health Care Solutions and Advanced Technologies

FEDERAL COMMUNICATIONS COMMISSION

Federal Register Volume 82, Issue 89 (May 10, 2017)

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.

[Federal Register Volume 82, Number 89 (Wednesday, May 10, 2017)]
[Proposed Rules]
[Pages 21780-21788]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-09309]


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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.

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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: http://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 
[email protected]. 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 [email protected] 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: [email protected]; 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 
[email protected] (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 [email protected]. For additional 
information about the Connect2HealthFCC Task Force, please visit the 
FCC's broadband health hub at http://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

[[Page 21785]]

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

[[Page 21787]]

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