Why 5G matters for healthcare

One central barrier stands in the way of reliable, instantaneous telecommunication, according to Dr. Shafiq Rab, chief information officer at Rush University System for Health: internet bandwidth.

The same limitation that makes an internet connection feel slower when trying to download data-heavy files or when multiple users are working on the same network presents a hurdle for burgeoning medical practices like physician-to-physician consultations, at-home monitoring and video-based telemedicine.

“When you go into a crowded place, there are 20 people with everybody going, ‘I can’t download this, I can’t download this,’ ” Rab said as an example. “All those things are limited by bandwidth.”

That’s why Rush, an academic health system in Chicago, plans to be the first U.S. healthcare organization to formally try using 5G—the newest generation of wireless internet—in a hospital setting. 

5G internet connectivity is expected to revolutionize nearly every industry. President Donald Trump has been one of its top advocates, calling 5G deployment a “race America must win” during a briefing last month. As part of his remarks, Trump pledged to take steps to encourage local governments and telecom companies to invest in 5G.

“5G will be as much as 100 times faster than the current 4G cellular networks,” Trump said, according to a White House transcript. “It will transform the way our citizens work, learn, communicate and travel. It will make American farms more productive, American manufacturing more competitive, and American healthcare better and more accessible.”

And health IT experts say that may, indeed, happen.

On a 5G network, a user could load a webpage or download a file somewhere between 10 and 100 times faster than today. Most major smartphone developers plan to release devices that support 5G connectivity this year—in fact, a handful already have—making it possible 5G service will be broadly available in the U.S. by 2020.

That makes Rush one of the “pioneers” of 5G, according to Rab. “But I think by the end of this year, it will become popular everywhere,” he added.

The College of Healthcare Information Management Executives has been touting the technology’s benefits, as well. The group made its voice heard earlier this year, submitting a statement to a Senate subcommittee ahead of a hearing it convened with telecom providers and government officials to discuss the importance of deploying 5G nationwide.

In its statement, CHIME—which is chaired by Rab—said there’s “no question that the infusion of 5G into healthcare will enhance access to care.”

“We need faster, better capabilities to be able to leverage the kinds of technologies that are both in the marketplace and entering the marketplace,” Leslie Krigstein, CHIME’s vice president of congressional affairs, said in an interview after the hearing.

Powerful players in the healthcare industry have turned their attention to internet infrastructure in recent years, arguing that connectivity has become integral to healthcare access.

The American Medical Association in November adopted a policy to advocate for expanded broadband and wireless internet access across underserved areas of the U.S. Lack of internet access or poor service in these regions has hindered the availability of emerging digital health services, such as telemedicine, according to the AMA.

“Without broadband and wireless, patients in underserved areas will face even greater health challenges,” Dr. Gerald Harmon, former chair of the AMA board of trustees, said in a statement announcing the new policy last year.

There’s certainly a disparity between those with and without internet. As evidence of a digital divide, the Federal Communications Commission in a 2018 report found that in rural America 31% of people lacked access to wired broadband that met the FCC’s speed benchmark.

A 5G network could be a boon for rural areas seeking access to internet-connected healthcare services, thanks to 5G’s use of “small cells,” or radio equipment placed on existing structures, such as buildings. “There is the potential to aid some of those that broadband has left behind,” Krigstein said. “Because 5G has the potential to be leveraged at a local level and has a different infrastructure, we have the hope that we will be able to avoid some of those similar access challenges, particularly in low-income or rural areas.”

Of course, that depends upon telecom giants such as AT&T, Sprint and Verizon setting up small cells and antennas in areas that need them. AT&T’s mobile 5G rollout encompasses parts of 19 cities as of last month, and Verizon has started in Chicago and Minneapolis. AT&T plans to launch 5G in Chicago, including at Rush, later this year.

But 5G’s possibilities stretch beyond broadening access. Healthcare analysts say much of the technology’s potential revolves around cutting down latency, which is the time lag between when a user requests an action—such as by clicking on a webpage—and when the network responds. 5G will supposedly get that reaction time down to just milliseconds.

That sets the stage for faster data transmission between remote monitoring devices and near real-time telemedicine visits. “A lot of the building blocks of change are already in motion,” said Brian Kalis, Accenture’s managing director of digital health. “The benefits of 5G are bringing down barriers to broader scale and expansion of things that exist in the market today.”

One of the most exciting possibilities for 5G is making robot-assisted telesurgery widespread. That’s an activity where any lag between a physician’s motion and a network’s reaction would be unacceptable, according to Spandan Mahapatra, global head of the business solutions unit at Tata Consultancy Services, an IT services and consulting firm.

“If there is any network latency—could you imagine the impact that would happen because of even a minor gap there?” he said. “It would be a major problem.”

Cue 5G’s supposed low latency.

The first 5G-powered robot-assisted telesurgery was already conducted in China earlier this year, albeit on a laboratory animal, according to Chinese telecom giant Huawei. That’s a first step to assessing the feasibility of using the technology on real patients—but Accenture’s Kalis suggests we’re still more than a decade away from it becoming standard practice.

“The overall rollout of these technologies and new models will take time,” he said, noting the need to ensure new care-delivery methods maintain safety and quality standards. “In general, deployment of medical technologies or new ways of delivering medical technologies take anywhere from 16 to 17 years based on prior research.”

Rush joined the 5G movement in January, announcing its intent to become 5G-enabled through a contract with AT&T.

Under the partnership, which AT&T characterized as a “trial agreement,” the company will set up small cells in strategic places around the health system’s flagship hospital, Rush University Medical Center. Rush is also integrating services from AT&T that will allow the hospital to route specific application traffic to different cloud servers, so it can manage traffic across the 5G network. Rush and AT&T’s goal is to test how 5G can improve various hospital processes. It’s part of an effort to better understand how quick speed and low latency can help to create a “smart hospital,” according to Mo Katibeh, chief marketing officer at AT&T Business.

AT&T’s public comments on the agreement are short on details—the company wouldn’t confirm when 5G would be in use at Rush, but said planning is underway. “We’re not getting into the timelines and deliverables of the trial,” Katibeh said.

But Katibeh spoke to sweeping ideas about the potential for 5G internet to improve hospital operations.

“Rooms then could be intelligently scheduled, patient care enhanced using machine learning and artificial intelligence,” he said of 5G’s possibilities. “And then, one that I’m personally really excited about is how will virtual reality and augmented reality be used to train medical students to help them become better doctors, faster?”

As an example of one project the duo is pursuing, Rab shared what he said will be one of Rush’s initial use cases: testing how quickly medical staff can send and download large packets of data from one end of the hospital to the other. In the not too distant future, Rab suggested a physician could perform a telemedicine visit while simultaneously downloading an entire MRI in seconds, without disrupting the connection.

“The most important thing that we’re testing is heavy load of images,” Rab said, noting musculoskeletal MRIs as an example. “A second that we’re doing is, when we send emails and attachments to each other, can we send 8 megabytes or 10 megabytes of PowerPoint slides from one side to another without a problem?”

There’s also a cost-saving component. 5G will arguably be more affordable than upgrading the hospital’s extensive wired infrastructure, a process that can cost thousands of dollars per cable install—and those cables add up, according to Rab. He said the health system may save up to $5 million with 5G, despite initial investment costs.

AT&T has not publicly announced its pricing plan for 5G service.

After 5G service is deployed nationwide, Rab said he hopes the technology will be able to help medical staff exchange data with patients almost instantaneously from afar, opening the door for “hospital-like” monitoring off-site. He said patients with various conditions would be able to be monitored at home, similarly to how patients are monitored in intensive-care units today.

“When you go home, your connection back to the hospital, your connection back to the doctor, your connection back to the nurses, does not stop,” he said, adding that “concurrent talking with five, seven, eight people together, your entire care team” via video chat “becomes possible” with 5G.

5G, with its quick speed and ability to transmit hefty packets of data, is expected to foundationally change the so-called internet of things.

The internet of things describes an ecosystem of devices that can exchange information with one another via the internet. In healthcare, that ecosystem—dubbed the “internet of medical things”—includes a wide variety of items, such as internet-connected medical devices, equipment and wearables, paving the way for constant remote patient monitoring.

5G “really brings together a lot of the applications that are dependent upon lots of data moving very quickly in a basically real-time environment,” said Ben Arnold, the Consumer Technology Association’s senior director of innovation and trends. “It’s not just about faster speeds to your smartphone. It’s about connecting devices and machines to each other.”

But hooking up these devices to one another comes with its own set of concerns. Having devices linked up within a hospital—or, in the case of at-home monitoring, between a patient’s daily life and the hospital setting—widens the possible “attack surface” a hacker can target to gain access to an organization’s network, said John Riggi, the American Hospital Association’s senior adviser for cybersecurity and risk. “The number of (connected) devices represents the number of access points that can be attacked to enter the network,” he said.

To mitigate the risk of internet-connected devices being used as “access points,” Riggi suggested hospital leaders purchase devices that offer password protection and data encryption. They should also continuously monitor how devices are connecting to one another and segment their networks, so that noncritical devices aren’t connected to core systems that hold patient data.

“5G is a great advancement, which holds great potential to improve the delivery of healthcare,” Riggi said. “If the risk is acknowledged and addressed at the outset, it can be dramatically reduced.” 

Back in Chicago, Rab pointed out that the trial with AT&T is to test 5G, including cybersecurity. “This is brand new, so we’re very cautious and testing for every inch of it,” Rab said. “We have to be cautious that we don’t claim victory or give people wrong answers. … Once you’re live on a network, you can’t go down.”

But for Rab, it’s about participating in a broader national mission at a time when countries such as China are, by many estimates, leading in 5G investment. 

“Our country needs to go forward,” he said. “We can never be second. We can’t let anybody else beat us. We have to take the bull by the horns.”

RELATED STORY: What is 5G?