Kristan Kline is in charge of network strategy for Kaiser Permanente, the nation's largest nonprofit health plan with 12 million members, 39 hospitals and $84 billion in revenue. He recently completed Cornell University's 5G for Business online program, but when he thinks about how wireless technology can solve business problems for Kaiser, 5G isn't the only technology that he is keeping an eye on.
"I think that story is starting to become a lot more solid with CBRS," he said, pointing to the newly free 3.5GHz spectrum band, dubbed the Citizens Broadband Radio Service (CBRS). "There's a lot more people talking about 5G and that is interesting because it has great promise in the macro, but the 5G story is not as clear inside buildings," he said, adding that the premiere 5G use case of robotic surgery is not something he expects to see in his career.
Patient monitoring and critical communications are the use cases that Kline needs to support with robust networking technologies. Currently, most Kaiser Permanente connected devices use cables, dedicated wireless frequencies, or Wi-Fi. "We've been progressing Wi-Fi because we have to be really good at it and we're going to have to be really good at it going forward, but I see this impending wave of additional devices and we're going to have to have an answer to 'how do we deal with that?' " said Kline. "CBRS came at the right time to be a potential answer."
Why is CBRS of interest when the government has already set aside specific frequency bands for wireless medical telemetry? Kline said medical equipment makers find it costly to operate these one-off networks and many of them want to reconfigure their devices for Wi-Fi, since Wi-Fi is already in place at most hospitals. Kline predicts that device makers will try Wi-Fi and ultimately decide they need higher service levels and more security.
"Private LTE will show up I think as a good choice as they work through it," he said. Indeed, the CBRS band has been touted as ideal for such indoor, private wireless LTE networks.
Chicken and egg problem
Kline knows he will have a hard time convincing Kaiser's finance teams to invest in a private wireless network in the CBRS spectrum band until medical devices with CBRS radios come to market. But device makers are unlikely to support the technology until networks are in place. "I'm trying to short circuit some of that with discussions with various partners and vendors that we have," Kline said.
"We have to state the need and work with the vendors," he explained. "There's a tipping point of device availability that has to happen. And right now there just isn't a lot of innovation in the critical care device space … at least that's being publicly mentioned."
But Kline is optimistic, based on recent conversations with the vendor community. Kaiser Permanente has innovation centers where it can test technologies without involving actual patients, and Kline hopes to include several vendors in a trial at one of these labs in the not-too-distant future.
Making the business case
If tests are able to demonstrate the potential for a return on investment with a CBRS private wireless LTE network, Kline said Kaiser could move to a small, regional deployment, and if that succeeds it could expand in the region or even nationally. He said Kaiser's regions have some budgeting autonomy, and do not all have to make identical technology choices. This could be particularly salient for CBRS deployments, since Kaiser hopes to use unlicensed CBRS bands instead of paying for licenses. Kline knows that spectrum availability could differ from region to region.
"We believe that we have enough spectrum to do this notion of critical communications with GAA [the unlicensed portion of the CBRS band], but we won't know until we really try it," he said. "The science says we should be OK, especially with our indoor use. But the danger is that if it turns out we have to do a PAL license [the licensed portion of the band], I think it makes that business case harder to achieve."
Kline said Kaiser will engage a technology partner instead of trying to build CBRS wireless networks on its own. He hopes that as vendors, integrators and neutral hosts become more familiar with CBRS, an ecosystem will develop. "When you can pick an equipment provider and local or regional deployment partner that can give you options for deploying the equipment in a capex or opex model, I think that's when you'll start to see organizations like ours really pick up on this," he said. "We're talking about a new ecosystem for advancing healthcare on private LTE."
— Martha DeGrasse, special to Light Reading. Follow her @mardegrasse