Wyden Says Broadband Spending Would Spur Health IT

"There are big, big traffic jams and unpaved roads on the information superhighway that’s called the Internet, and that is holding back improvements in health care for those in rural and tribal areas,” said Wyden. Health IT can keep seniors healthier at a lower cost, especially for those living in remote, rural areas, said Committee Chairman Herb Kohl, D-Wis. But “several stumbling blocks stand in the way” of healthcare technologies in the home, he said. “Significant barriers and misaligned incentives must be removed before the private sector can start producing solutions,” said Mohit Kaushal, director of the FCC’s healthcare team for the plan.

E-care technologies hold the most benefit for seniors and rural areas, but “those are the two categories where broadband and digital literacy is the lowest,” said Sen. Susan Collins, R-Maine. “The cost issues perhaps can be solved through subsidy,” but “cultural issues” are more complicated, she said.

Kaushal agreed low broadband adoption by seniors and sparse access in rural areas are big problems. Only 35 percent of seniors over 65 have adopted broadband because they aren’t digitally literate, don’t see broadband’s relevance, or think the price is too high, he said. And 3,600 small physicians office aren’t served by mass-market broadband, he said. Bringing broadband to rural areas may lead to more demand by seniors, said Farzad Mostashari, senior advisor for the Health IT National Coordinator in the U.S. Health and Human Services Department. Access to useful and cost-saving healthcare technology will give many people “reason to go online,” he said.

The National Broadband Plan has good ideas on health care, but action must still be taken, said Eric Dishman, Intel global director of health innovation and policy. The healthcare recommendations in the plan are “likely to dissipate if someone does not watchdog this,” he said. “Many of the people who created this broadband plan are not going to be at the FCC in four months.” Dishman urged Congress to establish a national coordinator to build a tele-health and e-care strategy, he said.

Wyden waded into net neutrality late in the hearing, asking Dishman and two law professors if health IT should get a priority lane on wireless broadband networks. Wyden hasn’t decided whether it’s “appropriate for the Congress or the [FCC] to start thinking about … an HOV lane for e-care data for wireless broadband,” he said, “but at some point Americans are going to ask” if someone reading movie reviews should be allowed to slow down transmission of emergency healthcare service. Dishman agreed “we need to be exploring use cases for the technology that say heart rate data for a critical patient needs to be” prioritized over “a recipe being exchanged.”

Besides broadband access, outdated rules and bad economics are barriers to health IT, Kaushal said. “Technology alone will not solve our health care challenges. It must be coupled with payment reform, innovation in service delivery, and improved regulatory transparency before we will recognize the health benefits and cost savings promised by these technologies.” Kaushal called for coordination across government, and with the private sector and healthcare community.

Congress should direct the Health and Human Services Department to propose “specific programs and reimbursement changes” to “help realize the value of e-care technologies,” Kaushal said. “Within a fee-for-service reimbursement system, providers bear the costs of health IT implementation and changes to workflow but don’t fully capture the economic gains they create through improved clinical outcomes.” And policymakers should revise existing regulations that thwart adoption of e-care technologies, he said. “State licensing, credentialing, and privileging rules prevent physicians from providing remote broadband-enabled care across state lines and even at other hospitals than their usual place of work.”