For many health care providers, particularly those in rural areas, the lack of a fast, reliable Internet connection presents a huge, if not insurmountable, obstacle to achieving the meaningful use of health information technology. To that end, in March the Federal Communications Commission (FCC) released the National Broadband Plan, which carries the primary objective of ensuring that all Americans have access to high-speed Internet.
Likening today’s broadband infrastructure expansion to the electricity build-out of the early 20th century, the FCC’s plan positions high-speed Internet as a “foundation for economic growth, job creation, global competitiveness and a better way of life.” Reducing the cost of health care by deploying health IT enabled by broadband, from electronic health record (EHR) technology to telehealth services, is a key element of the plan.
- How does the National Broadband Plan relate to health IT?
- What does the FCC have to do with health care?
- What are the recommendations for accelerating the adoption of telehealth?
- What are the recommendations for promoting health IT, data interoperability and data access?
- What is the Rural Health Care Program, and what are the recommendations for it?
The National Broadband Plan spells out how Congress, federal agencies and state and local governments can promote the deployment of broadband infrastructure and the adoption of broadband-enabled technologies. This, in turn, promises to stimulate investment and innovation in education, public safety, government and health care. The FCC estimates that such technology could reduce health care costs by $700 billion in the decades ahead.
Traditionally, the FCC’s role in health IT would be limited to network connectivity. However, the National Broadband Plan’s recommendations for health care go well beyond connectivity to address the challenges involved in persuading providers to use health IT. The commission is expanding its purview in this realm because, in its own words, "it is the ecosystem of networks, applications, devices and individual actions that drives value, not just the network itself."
The federal government sees widespread broadband deployment, coupled with the adoption of health IT, as key to facilitating three objectives in health care reform:
- It would make the collection and exchange of health-related data more efficient by facilitating the use of EHR technology.
- It would support video consultation, remote patient monitoring and other aspects of telemedicine to improve rural health care.
- It would lay the groundwork for future innovation.
E-care, also referred to as telehealth, is the electronic exchange of information to assist health care providers and aid advanced analytics. It includes telemedicine, which describes the set of technologies that enable remote monitoring, video consultation and image transmission.
The National Broadband Plan offers several recommendations to stimulate the adoption of telehealth service, including the following:
- Congress and federal agencies should promote investment in telehealth services as they have promoted investment in EHR technology. Likewise, they should provide financial incentives as they do for the meaningful use of EHR.
- Congress should consider tax breaks or other incentives for large-scale private telehealth pilot programs.
- The U.S. Department of Health & Human Services (HHS) should rank telehealth applications that are worthy of reimbursement and support pilot programs and testing of nascent telehealth applications.
- The government could boost the adoption of telehealth services by taking a new look at the standards by which providers are licensed, credentialed and given privileges, as well as the process by which devices are approved.
The plan notes that health data is generally held in proprietary systems, making it hard to collect and aggregate. While meaningful use aims to make it much easier to collect clinical information, it still will be hard for researchers to gather the data in a standard format. Merging administrative and clinical data could help move to an outcomes-based reimbursement system. The vision, according to the plan, is “to enable a continuously learning and adaptive health care system that ubiquitously collects information, aggregates it and allows real-time analysis and action.”
To the FCC, a number of laws and regulations stand in the way of collecting and aggregating health-related data more efficiently. Additionally, regulatory uncertainty hampers investment in these electronic health care technologies. The plan covers numerous areas for improving health data interoperability so that it can be more easily aggregated:
- Congress and state legislatures should reduce regulatory barriers to adopting health IT, such as restrictions on a physician’s ability to utilize electronic prescriptions for controlled substances. (Note: The Drug Enforcement Agency released a final rule on e-prescribing for controlled substances a few weeks after the National Broadband Plan came out.)
- States should change their licensing requirements so practitioners can treat patients across state lines.
- The Office of the National Coordinator for Health IT (ONC) within HHS should set uniform standards for sharing health care data and should provide incentives for using those standards.
- Congress should update the Health Insurance Portability and Accountability Act to make consumers “authorized persons,” meaning they would actually be able to receive their own digital lab data.
- The FCC and the Food and Drug Administration (FDA) could clarify the requirements and approval processes for health care devices and converged communications. While general-purpose devices such as smartphones are regulated by the FCC, remote-controlled drug-release mechanisms and other medical devices are regulated through the FDA.
The Rural Health Care Program is a subsidy initiative that the FCC launched following the Telecommunications Act of 1996. Funded through the FCC’s Universal Service Fund (USF), the program provides subsidies to public and nonprofit rural health care providers for telecommunications services and Internet access. In 2007, the FCC created a pilot program within the Rural Health Care Program to specifically subsidize the initial capital expenses of broadband network deployment and the recurring costs for five years.
The National Broadband Plan spells out recommendations for reforming the Rural Health Care Program and ensuring sufficient connectivity for health care facilities. Most cover ways to increase or expand subsidies to health care providers or broadband service providers for promoting the use of high-speed Internet services. Additional recommendations include the following:
- Anyone participating in the Rural Health Care Program and qualifying for USF subsidies should be required to meet “outcomes-based performance measures” that would be similar to the criteria for the meaningful use of EHR.
- Long-term care facilities, data centers, off-site administrative offices and other locations should be allowed to participate in the Health Care Broadband Access Fund and Infrastructure Fund.
- Congress should make some for-profit health care providers that serve vulnerable populations eligible for USF funding.
Following through on this aspect of the National Broadband Plan, the FCC on July 15 issued a detailed proposal to boost broadband investment in rural areas. Under the proposal, $400 million would be spent annually on not only deploying networks, but also subsidizing providers’ monthly connectivity costs. Such an investment in network infrastructure, according to the FCC, will in turn generate investment in telemedicine, EHR systems and other key health IT.
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