Tuesday, March 2, 2010

FCC Finds Gaps in the Current Broadband Infrastructure and Proposes a National Broadband Plan


Includes discussion of connectivity issues that hinder the adoption of Health IT and the transformation of the Rural Health Program to address them

Washington, D.C. – March 2, 2010 – Broadband will play an increasingly important role in supporting health care delivery in the United States. However, the country’s existing broadband infrastructure, reimbursement policies, and regulations inhibit the meaningful use of health information technology to advance health outcomes and lower costs.

A National Broadband Plan being developed by the Federal Communications Commission includes many working recommendations for addressing these shortfalls. With the deadline for delivering the Plan to Congress just two weeks away, the National Broadband Plan’s Health Care Director, Dr. Mohit Kaushal, discussed many of the working recommendations at the HIMSS10 - Healthcare IT Conference and Exhibition” conference on March 2 for the first time.

As part of the announcement, Dr. Kaushal detailed how the FCC is re-vamping its $400M a year Rural Health Care Program to play a critical role in closing the broadband connectivity gap for health care providers while aligning the Commissions efforts with the emerging “meaningful use” criteria being developed at HHS. Dr.  Kaushal explained that the FCC will seek to implement recommendations promptly after the Plan is conveyed to Congress

The plan also recommends changes to health IT reimbursement policy, better utilization of health IT data, and increased collaboration between the FCC and the FDA.

As part of the event, Dr. Kaushal was joined by senior health IT leaders from across the federal government – including the Department of Health and Human Services, the Indian Health Service and the Department of Veterans Affairs.

Discussion topics for this event included the following:


The FCC announced results of one of the first ever comprehensive analyses of connectivity for health providers in the US.  The findings include:

    * An estimated 3,600 small practices lack access to even the basic broadband services they require to achieve meaningful use.
    * Tens of thousands more locations face prices that differ significantly, often by $45,000 or more per year for the same level of service. The gap is substantially larger for rural providers. These disparities offset meaningful use incentives.
    * Safety net providers are at a disadvantage in securing broadband solutions, leaving greater hurdles for some of the nation’s most underserved citizens to benefit from health IT. Mass-market infrastructure leaves behind one in three Indian Health Services sites.  92% of their locations rely on a connection of 1.5 Mbps or less, constraining the adoption of video consultation, remote image diagnostics, and EHR technology.


The FCC proposed transforming its Rural Health Care Program, which is authorized to spend $400M per year, to help health care delivery locations meaningfully use health IT. The FCC’s program is the largest sustainable government initiative focused on healthcare connectivity. The fund has historically been underutilized, and the proposed reform will aim to address the connectivity needs for meeting “meaningful use” requirements.  Key elements include the following:

    * Create a Health Care Broadband Access fund that

–   Helps health care providers purchase broadband services anywhere they are unaffordable, including urban settings; and

–   Expands the program to more institutions, including behavioral health centers, long-term care, and data-centers and for-profit providers that serve particularly needy populations.

    * Create a Health Care Broadband Infrastructure Fund that

–   Helps healthcare providers deploy new broadband networks where existing infrastructure is insufficient;

–   Makes it easier for health care institutions to coordinate with community anchor institutions as well as simplify rules that allow private network operators to partner with projects to bring broadband to underserved communities; and

–   Makes applications and project management easier so that healthcare professionals can focus on results, not program administration.

    * Link funding to “meaningful use” and other performance measures to ensure support goes to locations that are appropriately utilizing broadband-enabled health IT; and
    * Recommend Congress increase broadband appropriations to the Indian Health Services to provide them the resources to upgrade to the minimum connectivity requirements and evaluate whether investments in other federal providers are warranted.


Improving broadband connectivity is necessary but does not close the health IT gap on its own.  Providers need reimbursement for health IT and other economic incentives.  The Plan will recommend that the federal government do the following:

    * Make efforts to increase e-care pilots that help transition to an outcome-based payment model. Future iterations of ONC’s meaningful use program could offer one avenue for implementing these reimbursement changes.
    * Expand reimbursement for e-care under current fee-for-service model where outcomes are proven.
    * Provide Congress with a plan to realize the value of e-care for the long-term. After 12 months, Congress should convene a panel to review HHS’s recommendations and take Congressional actions that will ensure these technologies’ wider adoption.


To ensure the government is not inhibiting innovation and adoption, the Plan also addresses regulatory barriers, including efforts to

•     Revise credentialing, privileging and state licensing requirements to enable e-care.

•     Clarify regulatory requirements and the approval process for converged communications and health care devices. As part of this process, the FCC and the FDA will seek formal public input after the plan is released and hold a workshop with representatives from industry and other relevant agencies to examine real case studies.

•     Drive innovative applications and advanced analytics through the evolution of Meaningful use to further interoperability across administrative, research and clinical data.

•     Ensure that patients have control over and access to all of their health data. Congress should update HIPAA, with suitable exceptions, to include consumers as “authorized persons” of their digital lab data. In a similar vein, barriers to consumer control and access relevant to all other forms of health data should be examined and removed.


The American Recovery and Reinvestment Act of 2009 directed the FCC to submit a National Broadband Plan to Congress that addresses broadband deployment, adoption, affordability, and the use of broadband to advance solutions to national priorities.  More information about development of the National Broadband Plan can be found at www.broadband.gov

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