Healthcare providers determine how to best use ultrafast 5G

The same technology expected to make increasingly immersive virtual reality, driverless cars and other “smart” products possible will also improve hospital processes and patient care—at least, that’s what some early adopters are hoping.

A small number of healthcare organizations in recent years have struck partnerships with telecommunications companies to try out 5G—the newest generation of wireless internet—for an expansive roster of innovative tech projects, including programs related to augmented and virtual reality, robot-assisted telesurgery, and data processing.

The hope is that 5G will offer a significant improvement over 4G and other types of internet infrastructure, where many of those projects are already in use today.

The 5G technology standard is expected to “support higher density with faster speeds,” said Danny Kim, director of information technology at the Lawrence J. Ellison Institute for Transformative Medicine of USC.

The institute is testing out 5G at a new cancer research and treatment facility it opened last year, making it one of the healthcare organizations taking the lead to try to figure out the best applications for 5G.

Though 5G on its own won’t be a game changer, it will underpin other innovations that could be. Designed to offer significantly quicker speed, lower latency and higher bandwidth, 5G could let organizations connect more devices to a network without worrying about the internet service slowing down, opening the door for better remote patient monitoring or tracking additional assets inside of a facility. It could also allow physicians to share large files more quickly and run virtual reality that’s smoother and more responsive to commands.

“When we’re thinking about 5G, we’re also talking about (the internet of things), we’re also talking about cloud computing, we’re also talking about (artificial intelligence),” said Michela Landoni, a telecoms analyst at Fitch Solutions Macro Research.

Experts from five early adopters and one that is waiting shared how they’re approaching 5G and where they see the most potential for the technology.

Vitas Healthcare, a hospice and palliative-care provider based in Miami, in 2018 launched a research project to test whether VR delivered through a 5G network could help reduce chronic pain and anxiety for patients receiving end-of-life care. Researchers hope that, in some cases, it could serve as an alternative therapy to pharmaceuticals like opioids.

With VR, hospice patients can virtually walk through calming scenes like national parks or travel to Machu Picchu in Peru. Patients who are veterans have also had the option to visit war memorials.

The study, which Vitas has had to pause due to the COVID-19 pandemic, involved visiting hospice patients either at home or in a long-term care facility for the VR experiment. Patients used VR headsets from company Magic Leap, and AT&T, a partner on the research project, provided the 5G network and some of the VR video content.

The study is jointly funded by Vitas and AT&T, with AT&T primarily supporting the launch of the pilot and Vitas funding the study’s expansion since.

Other healthcare organizations have tested VR for pain management. But 5G’s quick speed and low latency could make it easier to download and stream large video files for VR while caring for a patient at home, according to Dr. Joseph Shega, chief medical officer at Vitas. “Without 5G, so many experiences are limited to what’s in the headset,” Shega said.
5G could also make it less likely that the video has lags that can  make a patient feel nauseous.

As part of the study, researchers track a patient’s vital signs and ask patients to score their pain symptoms before and after the VR. It’s too early to share study findings, but so far, patients have been responding well to VR, according to Shega.

Shega describes himself originally as a “skeptic” of whether VR could truly improve pain management but has been impressed.

“I was quite surprised to feel how immersed you could become,” Shega said.

So far, a few dozen patients in California have tried out the VR as part of the study. As the pandemic subsides, Vitas plans to expand the study to its patients in other areas of the country.

Eventually, after studying the technology, Vitas will consider expanding VR to its hospice patients across the U.S.

Dr. Ryan Madder, an interventional cardiologist at Grand Rapids, Mich.-based Spectrum Health, for the past seven years has been researching whether a doctor could perform vascular surgery on a patient from afar using remotely controlled robotic surgical systems. Ideally, that could help speed time to treatment if a patient is far away from a hospital with a specialist.

When a patient is having a heart attack, every minute until treatment counts. “The longer that the artery is closed, the worse that patient does, the higher the risk that the patient is going to die from that heart attack (and) the more damage gets done to their heart,” he said.

Initially, Madder’s research into robot-assisted telesurgery involved testing whether a doctor could control a robotic surgical system from one room over.

But the advent of new internet generations, such as with 5G, has opened up possibilities for performing a procedure from many miles away.

In surgery, any delay between a physician’s motion and the robotic system’s reaction could be disastrous—so 5G’s low latency is a particularly promising attribute.

In 2019, he simulated a minimally invasive heart procedure that spanned more than 3,000 miles through a project with Verizon. Madder, stationed just outside of Boston, remotely controlled a robotic system from Siemens Healthineers company Corindus—another partner on the project—to operate on vascular simulators in San Francisco.

Madder tested performing the procedure—a percutaneous coronary intervention—from Boston to San Francisco using a wired network and a 5G wireless network.

While the procedures had slightly greater latency compared with remote surgeries that spanned a shorter distance—from Boston to New York City, which are only about 200 miles apart—the perceived latency for the Boston-San Francisco procedure was still “imperceptible” to Madder on both the wired and 5G wireless networks, according to study results published last year in the journal Catheterization and Cardiovascular Interventions.

“Based on the results of that study, I don’t think distance is a significant barrier for what we’re going to be able to accomplish in the future for telerobotics in healthcare,” Madder said. “It’s very possible that telerobotics could almost be connected from any location in the U.S.”

Madder’s foray into 5G wasn’t the first experiment to test robot-assisted telesurgery with 5G. A surgeon in China performed a robot-assisted telesurgery in 2019, albeit on a laboratory animal, and a surgeon in Italy that same year directed a surgery from afar over a 5G network.

But there’s still more research needed before integrating robot-assisted telesurgery that spans such a far distance into patient care, including continuing to validate the technology and addressing questions like medical licensure and cybersecurity. Madder said he’s not sure how far off the healthcare industry is from seeing robot-assisted telesurgery become standard in patient care.

“The thing that’s very clear to me is that the technology currently exists to allow this to happen,” he said. “The technology is there. We just need to continue to understand how to best apply it.”

The Veterans Health Administration for the past year has been connecting facilities to 5G in select markets in California, Florida and Washington state.

Last year, the Veterans Affairs Department announced a research project to deploy 5G from Verizon at the VA Palo Alto (Calif.) Health Care System as part of a project to experiment with augmented reality, such as testing whether AR paired with 5G could improve surgical planning by quickly turning CT and MRI scans into detailed 3D images.

In February, the VA also shared plans to pilot AT&T’s 5G at the VA Puget Sound Health Care System in Seattle and T-Mobile’s 5G at the Miami VA Healthcare System. The VA’s investments into 5G so far have built on existing services agreements with telecommunications companies, according to a VA spokesperson.

The VA hasn’t established which use cases it will test first in Seattle and Miami.

“We’re really early,” said Daniel Mesimer, director of WAN/LAN infrastructure engineering and provisioning at the department.
The first step at those sites will involve testing mobile wireless hotspots and other devices on the 5G network to assess “base functionality” for speed and connectivity, Mesimer said. They’re considering projects involving AR, telehealth and wearables, but testing will ultimately inform which 5G projects the VA will tackle and when.

“We try to identify areas that we can use immediately and test out that technology,” Mesimer said. Then, “grow from there.”

A cancer research institute at University of Southern California in early 2020 revealed that a new building it was constructing would include a 5G deployment. The Ellison Institute opened the building—which houses cancer research labs and a treatment clinic—last year. The facility will include 5G service from AT&T, which is currently being installed. The building is designed to be a “smart facility” that’s “blanketed with technology,” said the Ellison Institute’s Kim.

One of the first projects the institute plans to test with 5G is for 3D pathology, a system its researchers have developed to compile flat images of cancer tumors and turn them into 3D visualizations for pathologists and researchers to view up close with VR. That’s a project that requires low latency and high bandwidth, so it’s a good fit for 5G, Kim said.

Emory Healthcare last year deployed 5G from Verizon at its innovation lab. The Atlanta-based Emory Healthcare Innovation Hub, which launched in 2018, serves as a mechanism for Emory to collaborate with partner companies—so far, there are nine—on developing, testing and validating digital innovation projects to improve healthcare.

Emory, Verizon and the companies participating in Emory’s Healthcare Innovation Hub plan to work together to try out projects related to 5G, looking at possibilities like using AR and VR in medical training, quicker and higher-quality video for telehealth, and connecting more internet-connected medical devices to the network without running into bandwidth issues.

In the fall, Emory will bring 5G to a surgical skills lab and a few operating rooms in the new Emory Musculoskeletal Institute, so that the innovation hub can work on developing AR and VR use cases for surgical training.

They’ve also started laying the groundwork for a “connected ambulance” project that uses 5G, in which an ambulance could be outfitted with imaging equipment that rapidly transmits data to a physician at an emergency department for analysis, so that a patient suffering from a stroke could be diagnosed more quickly.

They’re still working on planning for those projects, figuring out how to best study them.

But by becoming an early adopter to wire up their space with 5G, Emory can “begin exposing people (to 5G) and getting them to understand it—its assets and its limitations,” said Dr. Scott Boden, vice president for business innovation and chair of the orthopedics department at Emory Healthcare.

Not all health systems are rushing to step into the 5G ring. “It’s very exciting,” said Reid Stephan, vice president and chief information officer for Boise, Idaho-based St. Luke’s Health System. He’s particularly interested in the possibility of using 5G to improve telehealth access, process data more quickly and improve VR.

Stephan estimated the industry is a year or two away from seeing the first validated 5G uses, “but I still think we’re a ways out from seeing some of the true widespread benefit coming to fruition,” he said.

Stephan said 5G is a topic other C-suite executives at St. Luke’s have expressed interest in and occasionally asked him about over the past year. The health system is considering whether to add 5G to its facilities—such as in a new clinic that’s being constructed or in a hospital that’s being remodeled. But there are no immediate plans to deploy it.

Before deploying 5G, the health system would need to establish a specific use case related to quality of care or patient experience that “really makes sense based on the level of time … and potentially investment we’d have to make to do this,” Stephan said.