If the Federal Communications Commission has its way, the adoption of health IT in the United States will get a significant boost from a much wider availability of high-end broadband communications for healthcare providers than currently exists.
That will help drive the use of electronic health records and telemedicine, as well as futuristic technologies such as body sensor networks, which the FCC believes will be needed to make improvements in American healthcare.
The FCC laid out just how it thinks that could happen as part of a national broadband plan it published March 16, which was mandated by Congress in the 2009 American Recovery and Reinvestment Act (ARRA).
The healthcare proposals were included in the plan as a separate, 27-page chapter, which began with an overview of the problems facing the healthcare sector, including epidemics of chronic illnesses like diabetes, injuries caused through prescription-drug errors, a growing elderly population and the looming shortage of physicians.
Broadband is not a panacea, according to the plan. But as an underpinning for health IT it can certainly help. Traditionally, the FCC would have tackled this challenge through a network technology perspective, but in the case of healthcare the enabler is an "ecosystem" of networks, applications, devices and individual actions that will drive value.
So the FCC looked at a number of current and emerging technologies that it thought could mitigate many of the problems and be helped by better broadband access. These technologies included EHRs, remote patient monitoring and videoconferencing. The FCC considered the convergence of cellphone technology and healthcare, and apps coming out for that.
"What we've tried to do is tease apart what the barriers are, and what role the government has in helping to reduce those barriers," said Dr. Mohit Kaushal, director of healthcare for the FCC's broadband initiative.
Some of the healthcare proposals clearly have a chance at a quicker resolution than others.
The FCC already controls a large chunk of money in its Rural Health Care Program, some $400 million a year. It was created from directives set out in the 1996 Telecommunications Act as a way of subsidizing the telecommunications costs of public and non-profit healthcare providers.
However, it's greatly underused. Only a fraction of those eligible for the program take advantage of it, and consequently, less than a quarter of the money available is allocated each year.
Expand eligibility
The FCC wants to improve those numbers by expanding the rules for who would be eligible. Urban health clinics and for-profit physician offices are the only health providers in many rural and underserved areas and suffer from the same kind of broadband deficiencies, for example, but they are currently barred from the program. In rural areas alone, the for-profit rules bar over 70 percent of providers from participating.
Some of the changes the FCC can impose directly, such as a proposal to make behavioral health centers eligible for the funds. Including for-profit institutions will require congressional approval, and it's unclear how lawmakers will take to that. Large, for-profit hospitals provide many of the rural health services in some states, so it could be a tough sell for Congress to allow yet more subsidies to these already well-funded enterprises.
Even so, the FCC is already engaged in many of the things that will be needed to change the broader technology ecosystem. Kaushal pointed to the growing convergence of telecoms and medical devices for remote patient monitoring as an example of that.
It became obvious during the FCC's broadband proceedings that uncertainty over the regulations governing medical devices is preventing investment and innovation in that area, he said. So the FCC is working with the Food and Drug Administration, which regulates medical devices, to figure out what is required to make this technology space more amenable to developers.
The FCC also is working on similar efforts with other agencies, such as the Department of Health & Human Services and, particularly, the Office of the National Coordinator for Health IT (ONC) as it moves forward with its programs. The results will feed back directly into the development of these agencies' technology projects. These opportunities probably represent the most direct return on the FCC's broadband plans.
Meaningful broadband
The effects of other proposals aren't so certain. The FCC is making a major effort to change the way its funding is applied by tying the "meaningful use" entitlement program to its grants, for example, which in turn could change the way healthcare providers are reimbursed for their services. It's also been working with the ONC on how to apply meaningful use, and to improve coordination between its funding and programs the ONC is working on.
Along those lines, the FCC's broadband proceeding really is more about creating the right incentives for the use of technologies, Kaushal said, and that includes the correct way to reimburse people, given what they have to pay out and the disruption to their workflows they have to put up with.
"The fee-for-service model doesn't adequately incent for the use of these technologies," he said. "Meaningful use is really changing the paradigm to outcomes- based reimbursement to solve some of these problems."
However, it's not clear how meaningful use could be attached to FCC funding, particularly as the definition will likely change over time. Kaushal said the FCC won't have its own definition, so it all depends on how flexible the FCC can make its funding process to accommodate the ONC's deliberations.
In other words, the FCC's healthcare proposals are definitely still a work in progress, as is the overall broadband plan. Blair Levin, executive director of the FCC's Omnibus Broadband Initiative, admitted as much in referring to the plan as more of a "call to action."
The plan "is in beta and always will be," he said.
