FCC standards meeting calls for industry participation

FCC standards meeting calls for industry participation

Attendees agree that vendors should take lead

Medical-device manufacturers, healthcare providers, and the government agree that there is a pressing need for equipment standards to improve the use and acceptance of telemedicine technologies. But little consensus has been reached about who should take the lead in developing and overseeing such standards.

In an effort to address this disparity, the Federal Communications Commission (FCC) and Healthcare Open Systems & Trials (HOST) co-sponsored a one-day forum last month to promote the adoption of standards and open architecture for telehealth equipment and networks. The meeting attracted 150 clinicians, technologists, and industry and government representatives, who discussed how to begin implementing a standards process that satisfies the requirements of both manufacturers and clinicians.

"The lack of standards-driven plug-and-play technology is an enormous barrier to cost-effective telehealth solutions," said Lewis Lorton, executive director of HOST. "This was the first meeting to try and line up people interested in this issue, with the emphasis on what the clinicians need and how we can best take care of people."

The meeting included a session with FCC chairman Reed Hundt as featured speaker and breakout sessions that focused on standards issues for data classification and format, telehealth equipment, and telecommunications and interfaces. Hundt noted in his speech that the lack of interoperability is of particular concern to the FCC because it relates to the agency's new universal service policy. In fact, the HOST meeting was a direct result of recommendations made by the FCC's Advisory Committee on Telecommunications and Health Care, which suggested in its report to the FCC last October that the government should help industry and the medical community cooperate on this issue.

"Our aim in convening this meeting is not to suggest any particular set of standards, but to identify needs and encourage the organizations represented here to work toward the creation and adoption of those standards that will best help the telehealth industry to mature," Hundt said.

Ultimately, industry-set standards will be of greatest benefit to both users and manufacturers of telehealth equipment, he said.

The American Telemedicine Association in Washington, DC, is already moving in this direction. The ATA's technology task force drafted a white paper earlier this year that addresses several issues related to the future development of telemedicine technologies and includes recommendations for standards covering video compression and resolution. Among other things, the task force recommends that compression algorithms coded into hardware require a minimum of 384k bandwidth for real-time telemedicine applications. The task force also endorses the International Telecommunications Union H.320 standards, which cover the core technologies for multimedia teleconferencing.

"The technology has gotten ahead of the applications, and that has created even more of a demand for standards," said Dr. David Balch, vice chair of the technology task force and director of the Center for Health Sciences Communication at East Carolina University School of Medicine in Greenville, NC. "What we are trying to do is settle on a minimum bandwidth for the practice of telemedicine. But what really needs to happen is the different medical specialties need to set minimum standards for their applications."

This echoes one of the recommendations to come out of the HOST meeting's breakout sessions. All three discussion groups reiterated Hundt's call for standards to be determined by members of the healthcare informatics community and urged interested parties to get involved in ongoing discussions.

Even with all of these efforts, however, it is clear that the process of establishing telemedicine-specific standards is still in its infancy. And some believe there are much larger issues that must be addressed first.

"The reality is that the whole issue of standards with respect to telemedicine begs the question: Do we have standards for our existing healthcare delivery system?" said Jay Sanders, president of the ATA. "The whole country is wondering, what is our evidence-based reasoning for healthcare delivery and treatment? And the answer is, we don't have any."