PSTN Technology Transition - Healthcare

Transcription

1 PSTN Technology Transition - Healthcare Connected Healthcare Solutions Industry- leading provider of strategic training and solutions for remote patient monitoring. C o n n e c t e d H e a l t h c a r e S o l u t i o n s, L L C w w w. c o n n e c t e d h e a l t h c a r e s o l u t i o n s. c o m

2 Table of Contents About Connected Healthcare Solutions...4 Acronyms Used...5 Executive Summary...6 Where Did All the Payphones Go?...8 The Technology Transition...9 Global Impact on M2M Devices...10 The PSTN Network...11 PSTN - Capabilities and architecture...12 PSTN - Statistics...12 Remote Patient Monitoring (RPM)...13 Remote monitoring - Capabilities...13 Remote monitoring - Architecture...14 RPM architecture...14 Devices...15 Communication infrastructure...15 Remote monitoring - Industry characteristics...15 Remote monitoring - Statistics and growth...16 Impact on Large Patient Populations...17 Companies and products

3 Implantable device monitoring - Architectures...19 Regulatory and security...20 Other Affected Segments...21 Low-income regions...21 Disaster-prone areas...22 Planning the Transition...22 FCC leadership...23 The FCC and service providers...23 The FCC s challenging task, approach, and timeline...24 FCC approach...24 Transition timeline...25 PSTN Transition Technology...27 PSTN Transition - Telehealth connectivity ATA Service and solution providers...28 Technology solutions...30 References...31 Disclaimer

4 About Connected Healthcare Solutions Connected Healthcare Solutions is an organization of dedicated professionals specializing in the delivery of training and product solutions for remote patient monitoring technology. Our relationship with the industry's leading telehealth manufacturers, combined with our experience of nearly 1,000 deployments worldwide, provides the expertise needed to streamline Remote Patient Monitoring (RPM) technology and programs. Connected Healthcare Solutions' clients are both manufacturers and users of RPM technology, giving us the unique opportunity to help design products and features that add benefits, not complexity. These relationships ensure that our clients learn the best ways to improve their technology and RPM programs. Together with our clients, we design and implement long-term success strategies to achieve the best patient care possible utilizing healthcare technology. 4

5 Acronyms Used PSTN/POTS (Public Switched Telephone Network) Circuit-switched telephone networks providing infrastructure and services for public telecommunication including voice-grade telephone service. Common prior to advanced forms of telephony including Integrated Services Digital Network (ISDN), cellular telephone systems, and Voice over Internet Protocol (VoIP). NGN (Next-Generation Network) Includes architectural changes in telecommunication core and access networks. NGN is a concept in which one network transports all information and services: voice, data, media, etc. RPM (Remote Patient Monitoring) The transmission of biometric data between a homebound patient and clinical staff at a healthcare provider site. ICD (Implantable Cardioverter Defibrillator) A system that delivers therapy to treat patients with heart rhythm disorders. CRT (Cardiac Resynchronization Therapy device) A device used if a person s heart is not beating efficiently and they meet medical eligibility criteria. The device sends electrical impulses to both lower chambers of the heart, helping them beat together in a more synchronized pattern. IoT (Internet of Things) / M2M (Machine-to-Machine) The ability for objects, animals or people to be provided a unique identifier (IP address) and the ability to automatically transfer data without human-to-human or human-to-computer interaction over a network. 5

6 Executive Summary The PSTN and POTS acronyms are unknown to most; however, nearly everyone who has ever made a phone call, sent a fax, or connected to the Internet has used PSTN/POTS. Both PSTN (Public Switched Telephone Network) and POTS (Plain Old Telephone System) are used as interchangeable terms that have defined the telephony architecture since the late 19 th century. Whether making a simple phone call or surfing the Internet by connecting to an Internet Service Provider (ISP), until recently this was only accomplished with the copper-wired infrastructure of the PSTN network. As telephones became a common household item, the supporting infrastructure continued to expand and increase capabilities. Soon the telephone infrastructure became a cost-effective tool for personal and business needs. Fax machines and Internet connections quickly evolved, creating the IoT (Internet of Things) M2M (Machine-to-Machine) infrastructure. By the 20 th century there were approximately 200 million PSTN connections in the United States [1]. According to a Berg Insight study [2], by the end of 2011 nearly 2.2 million patients were using home monitoring technology, many of whom were transmitting data via PSTN. Over the past decade however, personal and business needs have evolved. Mobile access and the ability to transmit large amounts of data quickly have become mandatory requirements. Communication and cable companies including AT&T, Verizon and Comcast are investing heavily in wireless and Next-Generation Networks (NGN). Their investments continually promote millions of consumers and businesses to convert to high-speed connectivity, rapidly expanding the NGN infrastructure throughout the country. Technology that enables business transactions and data transfer is being developed and deployed on the NGNs at a record rate. From finance to healthcare, organizations are transitioning the way they do business into a connected infrastructure, with application and technology development outpacing security and regulatory regulations. Every year continues to present more data and integrity compromises, which has led to an increase in regulatory scrutiny and regulations. Beginning with the HIPAA Act, strict standards have been set for patient s Protected Health Information (PHI) that ensure its security, both in physical form and when it is transferred and stored electronically. Additionally, in 2013 the FDA released the guidance Radio Frequency Wireless Technology in Medical Devices and a draft guidance for management of cybersecurity in medical devices. Although regulations like these are not stopping the growth of NGNs, they are causing organizations to fully evaluate the impacts of new technology that requires a NGN, often leading them to seek solutions that enable trusted legacy equipment to operate in a new environment. By 2012, PSTN's base had shrunk to 96 million subscribers [1]. With substantially changed business models, communication companies are actively promoting the elimination of the PSTN network. Providers like AT&T have formally filed with the Federal Communications 6

7 Commission (FCC) to eliminate the requirement to support the decaying infrastructure. Citing an $8 billion cost saving over five years with NGNs compared to legacy architecture [9], and a high retirement rate of employees with the PSTN maintenance expertise, providers are concerned about business longevity. As wired and wireless subscription levels continue to increase, the POTS/PSTN base is quickly falling to unsustainable levels. Although it is impossible to predict the specific timeline of the POTS sunset, the end is inevitable, and likely sooner than those most affected will be ready for. *POTS Households with POTS only, no wireless or high-speed connection Although the communication architecture transition affects people and devices alike, this report focuses on the impact on technological devices; specifically remote patient medical monitoring technology. The report details the evolution of PSTN, the people and technology it supports, and the difficulties of maintaining the architecture. Finally, a review of currently available solutions for the PSTN transition and their functionality is given and discussed. 7