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>> c-span, created by america's cae companies in 1979, brought to you as a public service by your television provider. >> host: this week "the communicators" is on site at the federal communications commission here many washington d.c. it's their site of their first-ever mhealth innovation expo. it's a discussion about the future of health and technology. in this program you're going to hear from regulators and innovators. joining us on "the communicators" at the site of the fcc's's mhealth innovation expo is matt quinn, director of health care initiatives for the fcc. welcome. >> guest: thank you. >> host: why is the fcc involved in these matters? >> guest: we're involved in lots of ways in health care and in mobile health. one of the ways that we're involved is that we had an mhealth task force last year say here are some ways that fcc can

provide leadership in this area. we have a equipment certification program. so, basically, any piece of equipment that uses spectrum as a transmitter we approve as an agency. the other side is that we allocate spectrum. so spectrum is the oxygen on which mobile devices run, whether they be mobile devices for health or other areas. but in a more important sense, we have to collaborate and coordinate with both other federal agencies, but also with the private sector in helping entrepreneurs and innovators get to market. >> host: so let's take those three points that you made. spectrum, we think about it on the cell phone and other technologies. how do these devices depend on it? >> guest: well, in the case of apps that run on cell phones, 3g, 4g networks, that's part of that. but there's something called a medical body area network or men band. fcc was the first, provided the

first country in the world to provide allocated spectrum for medical body area networks. this is something that allows monitoring of vital signs without having to have intrusive monitors. it can really be a game changer in terms of tracking people's health and health care, and that requires allocated spectrum. another way that we support innovation with spectrum is something called medical micropower networks. and so all of these things have to have a spot on the u.s. spectrum map or else there's potential for interference with other things that are moving think the air. >> so for the spectrum that gets allocated for everyone, cell phones and the like, is there a special section of spectrum just for these types of devices? >> guest: yeah. everything has to have its spot. some things, for example, blue tooth and wireless mics and other things are in an area called unlicensed spectrum. so there's no guarantee against interference by with the device of the manufacturer.

and so you can understand it how in health care settings this could be a problem. so having allocated spectrum, for example, for mbands and other things is more and more important. >> host: so let's turn to the device makers, the app makers. what kinds of general technologies are we seeing in this kind of space? >> guest: well, there was just a study that showed there are nearly 20,000 health-related apps on the marketplace, but that's just one angle into this. in this room you see a diversity of all sorts of things, everything from wireless gateways and networks that connect medical devices together inside of a hospital to solutions to connect people to networks to the whole world of remote monitoring that's coming. even text or sms space apps and tools that are used for, for example -- [inaudible] >> host: so they all depend on the spectrum. if an app or a medical device maker depends on spectrum, does that mean they have to come to the fcc to get approval for its

use? >> guest: yes. and there are -- so if you look at the back of your cell phone, you go inside, there's a little fcc key. if there's not, i have someone to see you. [laughter] everything that's a transmitter of spectrum requires fcc approval, and we have an office, we have a lab in baltimore, in columbia that runs that, but we also deputize a number of certification bodies and labs. a lot of it's done in the private sector. >> host: now, does that fall directly under your jurisdiction or are there ohs that deal with that? >> guest: our office of engineering and technology led by julie knapp is in charge of that really important function as well as figuring out what the rules of the road are for spectrum. >> host: so anybody who uses or develops an app or develops a technology, uses spectrum be, they fall under regulation of the fcc. what's the balance between how much regulation the fcc provides and not wanting to stop

innovation amongst private companies? >> guest: well, this is really the focus last summer to this day. we worked with the fda and the office of the national coordinator and a federal advisory committee of really diverse folks, everybody from app developers to medical device manufacturers and in between to say what is that good balance between patient safety and spectrum. and innovation not just with mhealth, but with the whole array of health i.t., and how do the regulators and other entities that are involved work together so that it is not stifling innovation. the fcc's focus is reducing interference. not a very funny joke i made earlier, but fda is focused on patient safety. and we both have equipment authorization programs for products that use spectrum. recently, in august actually, fda put out guidance, technical

guidance on wireless medical devices. we assisted them and worked with them in putting that technical guidance for folks bringing those products to market. you have to go through both processes, but they're for slightly different things. so every platform, every app doesn't have to come through us. it may or may not have to go through fda, and they put out guidance for the very narrow set of those, but any platform that's a transmitter needs to come through fcc. >> host: matt quinn, when you talk about health information, you have to deal with areas of privacy and security. what's the fcc's role? >> guest: that's a very good question. we are not the lead agency in enforcing hipaa, that's the office of civil rights. we work really closely with the office of the national coordinator on the requirements, for example, around electronic health records. but we haven't really staked out a specific, you know, statutory role as it comes to health i.t. >> host: and hipaa is? >> guest: the health insurance

portability and accountability act which is the law of the land for both privacy and security of health care, but also for expediting administrative transactions. >> host: you talked a lot about working with partners, and you listed some earlier. talk a little bit about this partnership and how do you keep from getting in each other's way. >> guest: well, we keep from getting in each other's way by be understanding what we do. in my first few months here at fcc, a lot of it has just been explaining. so what are -- how is fcc involved in health care. probably the most commonly understood part of where fcc is in health care is we subsidize broadband for rural health care organizations. actually, our rural health care program and the new health care connect fund is a universal service fund for making broadband more affordable not only for rural health care providers, but more and more consortia of rural and urban

providers and everybody in between. this really aligns really closely with, you know, efforts by medicare and other folks to connect people and help them exchange health information. explaining that to them in that context, for example, how the health care connect fund can support their efforts is a real eye-opener for them. from the regulatory side, i spend every thursday afternoon at the fda. [laughter] talking through things. we have regular meetings with our office of engineering and technology. and, you know, we did a workshop with them recently, we're going to do some workshops on things like wireless in the future. so it's a technical conversation, but it's also, you know, getting to know people individually and personally conversation. >> host: you brought up the health care connect fund, so give us a status report on rural areas across the united states. how equipped are they to handle these new technologies? >> guest: well, there's two sides to this. one of them is health care organizations themselves.

so the institutions and connecting those. and we're getting a lot of progress on broadband to those folks. there are still some gaps, as commissioner clyburn talked about earlier, in getting broadband to people individually. and the fcc has taken some pretty exciting actions in that regard through the other programs. the other is just getting phones in people's hands that need them who are underserved, and that a's other parts of the universal service fund like lifeline. we've seen some pretty exciting partnerships between those who -- the phone companies who provide that service, medicaid managed care, organizations and app developers. so the power of mhealth and the power of broadband, getting it into individuals' hands as well as hospitals' hands are two goals that are related but operate in different ways. >> host: and so the fund provides money for that, how --

>> guest: the health care connect fund, the rural health program only subsidizes broadband to health care organizations. other programs are aimed at connecting people. and also bringing broadband service, actually, to rural areas and others. that's less under my purview. >> host: so you said about meeting with the fda, being here at the fcc, how often does your job involve telling what's happening in this world to the commissioners and the chairman himself? >> guest: the, well, the chairwoman was -- [laughter] commissioner clyburn was the chairwoman until recently. and so i am the person who shares that information along with oet and other folks. it's a new role. this is actually the role of director of health care initiatives was recommended by the mhealth task force, and they said we need somebody to sort of, you know, to work externally and collaborate, coordinate and

communication but also internally. so i spent a lot of time just trying to learn what others at the agency are doing and thinking about is there a health care context to it. and then bringing it to other agencies that might be interested. so her saw is part of hhs that deals with rural health care. at the conference in february, we organized a -- >> host: the conference is? >> guest: health information management society. everybody knows that. [laughter] it's a big health i.t. conference. we're having the first all-day preconference symposium on rural health i.t., overcoming the challenges ask seizing the opportunities -- and seizing the opportunity. and think about it as a big opportunity for all the government programs, the obvious ones like office of national coordinator and medicare but also u.s. department of agriculture and veterans administration and all of these folks to talk about their programs in context and then

have beneficiaries, health care organizations from that program to say here's how it actually works. >> wes joining us at the site of the fcc mhealth expo is kent dicks, what is leer connect? >> guest: it used to be formerly known as med ops out of scottsdale, arizona. we are a remote wireless remote patient monitoring solution to be able to put devices in patients' homes to be able to monitor and keep them well and have better outcomes and keep them out of the hospital. >> host: so these devices depend on the cloud and spectrum to operate? >> guest: they do. and they have a device i can show you today, they have wireless cellular technology using what's known as m to m technology -- >> host: which is? >> guest: the kind of technology you find in your car, in your laptop, in the parking meters that are out there, very economical in sending small

amounts of information to the cloud. >> host: walk us through how this technology works. >> guest: now, at alerer we have point of care devices for lipids, for a1c. we also do health management as well, health information exchange analytics. the whole spectrum of care. but this device is a regulation device to do ptinr readings. and typically a patient who's on coumadin would have to go to the doctor once a week to get a blood reading. my mom does that, goes to her doctor to make sure her blood thinners are working properly. in this device is produced by alere, it has about 100,000 patients at home, and the data goes into this device, and it can go to our service center, our nursing center, where they can help monitor the patient. if there's a problem, they can alert the patient's cardiologist on in this. what we're trying to do and what we are doing with this device is now we are connecting it to our

mobile link which has cellular technology which i talked about. connect the wire to the device, and once you take a reading, it'll send it automatically to the cloud using the technology, and into a back-end system where it can be monitored. >> host: like an ipad or some type of device. >> guest: well, i've got this on an ipad, with we've got a system whering set thresholds for a patient. there's multiple systems we can put it into, but this is our health con ii system which brings it in, alerts to be able to say i want the reading to be between one and three, and if it gets outside that range, then i want to act upon it. so from an efficiency standpoint be, a nurse that's looking at this can go through and if i'm doing well, then there's really nothing she has to do with me today. but if i'm outside of ranges, then maybe intervention needs to occur so i don't want go into the hospital. >> host: you have another type of technology that's web-based.

what's this device? >> guest: this is still under fda review, so we're not selling it yet, but this is a device to be able to talk to multiple devices around it. somebody who has comorbidities, so scale, glucose devices, the type that a patient would have in their house anyway. >> host: so how does it work? >> guest: so on this, if we sent this home with a patient who's like a copd patient, right? i've got oxygen saturation. don't look at my stats because they're actually pretty poor today. [laughter] but if you look at it, it'll go through and start looking, it's going to do a little bit of calculation, say what my oxygen saturation is, what my heart rate is, and once it stops, it's going to send it over to this device, and it's going to -- you can put your speaker here -- >> saturation is 94% and your pulse is 107. >> guest: so if you left it alone for right now, it

announces 94 over 107. it would actually start asking the patient questions. and fending on what -- fending on what program the patient's in, i've got this in a diabetes program, it's going to start asking questions like did you take your medication, did you exercise, has your blood glucose been below 60. we want to look at those type of behavioral parameters to determine if the patient's having any type of problems and if we these to intervene. >> host: so, kent dicks, for a company like yours, what do you look for from the fcc, other forms of government as far as making technology available? >> guest: we've worked with them for the last three or four years, when the fcc handed off between julius and margaret hamburg to make it easier to be able to get through fda so we have the right patient safety, right, to be able to do that with these types of devices, but also from the fcc side to be able to bring the most amount of spectrum to rural and highly

rural organizations and areas that are out there to try to get these devices in the patients' hands. and that's what the fcc is doing. they're allowing us to work with additional spectrum. they're allowing us to get things to market quicker through fc c-certification as well --. one of the things we are concerned about is the underserved population. as the chairwoman said this morning, i personally have testified for veterans affairs on rural and highly rural, you know, activity for veterans. if you are a veteran or any person, any u.s. citizen living in a u.s. area and it's a rural area and it's 3-5 hours away from your physician, you're going to tend to exacerbate the disease, make it worse. the next time you present is probably maybe going to be in the hospital, and it's going to be a higher health care cost. so we want to try to put this technology into place to be able to monitor people that are indigent population, elderly population, a rural population. the population that is consuming

15% of the health care costs that consumes 80%, that's what we want to target the keep them out of the hospital. >> host: kent dicks, the president and chief executive office of alere connect, thank you. >> guest: thanks so much, appreciate it. >> host: "the communicators" at the site of the mhealth conference joined by director mccarty, what's that title and what do you do? >> guest: so i am within the office of the national coordinator for health i.t. that's a part of the department of health and human services, and we focus on helping the health system to transform using information technology. within that, my specific office is really focused on bringing consumers, patients, caregivers, actual people into this process wherever possible. we believe in empowering people through technology. we believe that consumers to date are really an underutilized resource in improving not only their interactions with the health care system, but also

their own health. because really when you think about it, your health is very much dependent on what happens every day when you're miles away from the health care system. the little choices you make about what you eat, whether you exercise, whether to take your medications not to mention things like when to seek care and where. those are the things that really shape your health over the long term just as much as those critical interactions where you have surgery or receive a treatment. >> host: because we're talking about the world of mobile apps -- >> guest: yeah. >> host: -- medical devices and they're portable, what's the consumer sentiment towards that as it stands today? are they wary of it? are they trusting of it? how would you gauge that? >> guest: well, so, as you know, there's been an immense uptick of mobile phones and apps including health apps. i think many people are very interested in using them. i think some folks are having a hard time navigating, knowing which is the right app for me both because people sometimes have questions about efficacy

like how do i know that this app promises to do what it says it does, but also sometimes folks have questions about privacy and security. so one of the things that my office is working on is providing a model notice for health apps. so, for example, when you go to why a can of soup, you know how there's that consistent fda label that lets you look for the things that you're interested in, some people care about sodium, other people care about sugar or fat. so similarly, we're developing a tool -- and we've already done this for personal health records, but we're now expanding it to address other kinds of mobile and nonmobile apps and tools. this can help you say, okay, these folks do not resell my information, or this is how they use it so that, again, a consumer can help to kind of navigate this newly-growing and exploding field. >> host: so if you're developing a standard or just a requirement then that mobile app makers have to follow this standard? >> guest: right now it's

voluntary, it's not a standard per se, it's more of a consumer tool that can be used in a voluntary way. we are certainly going to promote its use. we have several major personal health record vendors who are already using it but, again, since we're revising it to apply more broadly to apps and tools, we're really working with folks in the private sector to adopt it more broadly because we really think it's to their advantage to be able to help explain to consumers what they do with information. and, um, one of the things that we're doing in the year ahead is we're going to be launching a web site which is going to help people find where they can get access to their health information. this ties into something called the blue button initiative which is about consumers getting direct electronic access to their own health information. so you click this thing, the blue butt beton -- here's a picture of a blue button right there -- and you can download your health data from a variety of different sources. could be from your doctor or your health system, so it might

be your health records, but you might get it from your health plan including information not only about what episodes of care you've had, but also what that cost. similarly, you could go to your pharmacy and pull down information like, okay, these are the medications i took. these are all different sources from which you can pull this blue button data. and what we at onc are doing, we're going to launch a web site that says, cool, how do i get my data? point me towards potential sources and also towards some apps and tools where i can use it. and this is actually where that tool that i mentioned comes in. we're going to have that on the site so that people can look at these different apps and tools and at least say, well, from a privacy and security angle how are these different companies using my data. >> host: i was going to ask you about that because all that information flowing around, if i'm the user, i'm concerned about who gets access to that. >> guest: right. so once you have it in your

hands as a consumer, it's now outside the realm of hipaa protections, and it's up to you to figure out what you do with your information. i think there will be increasingly amazing opportunities to plug it into apps and tools in addition to just simple things like just reading over your health record and making sure it's correct, you know? so there are simple things as well as, you know, sharing it with your doctor. those things are important. additionally, though, plugging it into apps and tools so you can do things like remember to take medications or maybe enter into a competition with a friend or family member about, you know, exercising more or managing a certain health indicator, you know, keeping your blood sugar under control or not eating too many cookies in the holidays, whatever it is. so, yeah, we want to give folks guidance on which apps and tools are going to be useful to them. >> host: because you're concerned about the consumer, do you have to convince those in the federal government, those you work with, you know, on better and clearer ways to communicate to the consumer about what we're doing and about

their health information? >> guest: i think a lot of folks, um, are increasingly within the federal government and in the private sector too realizing that the consumer is this underutilized resource. we're all trying to, these days, reform health care, improve health care which means not only, you know, more efficiencies, but better quality care, better health care outcomes. the only way we're really going to get there is if we engage consumers more. and a lot of the efforts to reform payments are already working toward that goal, but the point with mhealth is most people now have this tool, a ubiquitous tool in our pocket that can really help us make daily decisions that support those behaviors and those ultimate end goals of better care. so this is like an amazing opportunity that we need to take advantage of to meet our national health goals about health care. >> host: so the blue button initiative or other initiatives, does it get direct consumer input as far as how this thing should run?

>> guest: so that's interesting. absolutely, we bring consumers in at many points to think about policy, technology, all of our processes are open and transparent. as one example, one thing that we do is we run challenges for the developer community to encourage them to build consumer tools that use this blue button data in a structured way. and there's one that we're showcasing here at the mhealth meeting here at the fcc which the winner of a challenge that we put out is a company called ddmd, and it was a challenge that was co-designed with patients. we had patients weighing in on what kinds of apps and tools they'd like to see, but also voting on the outcome. so, absolutely, a big part of what my office does is makes sure that that consumer voice and perspective is really represented in everything. i think part of what's interesting and challenging is that part of what we're doing here -- dealing with here in this consumer engagement arena is really a cultural shift.

and that's a change both for consumers themselves and for health care providers. because in the traditional model, you know, it was more the doctor who made the diagnosis and kind of called the shots and said, you know, you should do x, y, z in order to meet these goals. and is we're really advocating for a more collaborative model in which there's more of a shared decision making about even what the goals are as well as a sharing of information. and we feel that marley enabled -- particularly enabled by technology, consumers can share a lot of information that is radically helpful to health care providers in making diagnoses or in troubleshooting or figuring out why something isn't working. i'm talking about the growth of things like wireless scales or all kinds of other devices that can help you collect information about your daily life and potentially share it with your provider which is something that we're just on the cusp of starting to figure out how to make that happen. >> host: are the providers

acceptive, or are they concerned about the power leaving -- >> guest: oh, my goodness, great question. some are incredibly receptive and innovative, others are not so sure yet, so it's this process of cultural change and it's getting, again, some consumers too fully embrace this idea. others say, you know what? i'd really prefer my doctor take care of everything for me. but the reality of the health care system is you cannot assume that your doctor is coordinating with any other doctors you may be seeing and knows every detail of your life. it doesn't happen. so if you want to make sure that you're getting the best care and you're likely to get the best outcome, you as an individual need to get involved, and you can use technology to make that easier for you. >> host: do you have personal health or technology that you use on the health side that you like using, and what would you share about what you like? >> guest: yeah, sure. so a couple things that i mentioned already, i do like trackers like the fit bit, i've used it.

i also have one of those scales that automatically updates your scale wirelessly, it puts your weight on a graph. you can choose to tweet that out, which i do not -- [laughter] nevertheless, it's nice to know that's there particularly during the holiday season. in terms of just kind of making sense of the information and sharing it, i do have a personal health record which i keep updated not just for myself, but really more importantly for my kids because i'm a mother, and i have kids who have allergies to medications and other complicated things, and i'm not going to remember so and so had, you know, strep throat in february, took that medication, it didn't work. i've got to write that down, and i've got to have it available on my phone so that that when i go into maybe i don't always go in to see the same pediatrician. i sometimes go into like a minute clinic or something, and i've got that info right there. so that's really important to me as well as some of the kind of general social networks about health that i enjoy experimenting with, you know,

some of the sites that you put out a challenge like i'm going to floss more, and you sort of like vie against your friends to see if they can also meet their own goals. so, yeah, i'm an enthusiastic user personally, yeah. >> host: where do you see this going in health technology, the whole kind of system, where do you see it in three to five years? >> guest: um, hopefully, it will be widely, even more widely embraced. i hope where this is going is that there will be a greater flow of information from the traditional health care systems to consumers and back and forth. right now i think you have two slightly separate worlds where, like, you've got the traditional doctors, hospitals, etc., they don't necessarily share the information that folks are collecting through these apps and tools. and i think through policies that are increasing ehr adoptions in which we're requiring that consumers be able to view and download their data through blue button, we'll get that flow going hopefully in both directions. so that's one thing i