Usman Qazi, PhD June 28, 2021
Abstract
The rise of telehealth during the COVID-19 pandemic has disrupted the notion of healthcare as a primarily ‘high-touch’ sector of activity. Meanwhile, the rollout of 5G wireless standards, currently under implementation, represents a paradigm shift in telecom with rich offerings for remote care, training, and facility management.
Beside utilizing new frequency bands capable of transmitting information at higher rates, 5G standards provide partial virtualization of the radio hardware and centralization of key functions. To leverage 5G for better patient outcomes and improve the proper guaranteed network service delivery, 5G provides network slices configured for specific performance standards such as low latency, high reliability and concurrency of data transport. As such, a diverse array of healthcare applications, with specific performance requirements, can be implemented on the same physical network, over different network slices. Key technical considerations for 5G use cases in healthcare are outlined. In conclusion, market factors shaping the adoption of 5G in healthcare are discussed.
Contents
Success of telehealth is driving interest in interactive models of remote care
Network virtualization is key to understanding healthcare systems powered by 5G
A spectrum of healthcare solutions will be enabled by optimized network slices
Healthcare’s path to 5G transformation
Success of Telehealth is Driving Interest in Interactive Models of Remote Care
Telehealth, boosted by wireless technologies such as 4G LTE and Wi-Fi, has been proving its clinical value. The COVID-19 pandemic has brought about a dramatic shift in virtual visits from urgent care to routine care. Technological enhancements matter in telehealth: An ongoing reimbursement debate underscores the importance of video-enabled visits.
More elaborate models of remote care are being implemented by leading hospitals. The hospital-at-home, supported by Medicare, improves both patient outcomes and provides a significant cost-benefit in providing acute care to the elderly. Meanwhile, the explosive growth of the Internet of Medical Things (IoMT) is enabling remote monitoring and remote interventions. Concurrently, artificial intelligence tools are finding a range of healthcare applications—from coding of medical insurance claims to diagnosis support in radiology. For faster performance, these tools can be coupled to remote care via ‘edge interfaces’ for cloud platforms where artificial intelligence applications reside.
Novel technologies for wireless connectivity are being implemented at both local and extended scales. While Wi-Fi 6 boosts local connectivity, fifth-generation, mobile broadband (5G) promises unprecedented reliability and speed in telecommunications. Also, unlike Wi-Fi 6, 5G provides connectivity and guaranteed data delivery. 5G thus enables remote operational technology, conceived for fast and reliable mission-critical operations. This technology, illustrated by driverless cars and smart roads, is readily applicable to healthcare.
5G innovations: ‘New Radio’ coupled with novel approaches to data transport
Much like the ethernet protocol that enables the internet, 5G is a set of global standards that, independent of specific hardware, reflect innovative approaches to both wireless technology, and networking infrastructure. There are four main improvements 5G brings to the table for mission critical communications, such as those in healthcare.
New Radio 5G utilizes additional radiofrequency bands to boost information transfer over previous 3G/4G LTE protocols. Signal transmission at higher frequencies is closer to line-of-sight paths. Consequently, 5G requires a significantly higher antenna density per area compared to 4G LTE.
Disaggregated and Virtualized Data Transport Network Under 5G protocols it is impractical to provide antenna base station hardware at all locations. Disaggregation allows key radio functions to be moved to the mobile core, which acts as a bridge to the internet (see Figure). These functions are also partially virtualized as software running on servers (see figure below). Disaggregation reflects a departure from previous 3G and 4G LTE network architecture, where the components of a network function were not defined by the standard, permitting easy lock-in by equipment vendors. In contrast, 5G introduces standardization at the sub-component level of a network function. With 5G, network deployments are rapidly reconfigurable with components that are, in turn, easy to update. This can significantly reduce capital expenditure on infrastructure. Further, disaggregation allows applications on the edge cloud computing to be brought closer to antennas. For example, a self-driving car would require a cloud-edge app featuring AI, while overall low latency would be a critical need.
5G Standards, Slicing, and Network Orchestration
Enhancements to 5G standards are being implemented in phases. The latest standard calls for providing:
Time and Synchronization Distribution to enable disaggregation and network slicing.
Stringent reliability: Essentially zero data packet loss.
Ultra-low latency (or delay) on the order of a millisecond between 5G users (a ten-fold gain over 4G).
Network Slicing to enable multiple virtual networks on one physical infrastructure
Very high signal transmission rate on the order of gigabits per second.
Specific 5G use cases may not require all these performance features. The process of slicing creates virtual networks optimized, say, for reliability vs. latency. To ensure the reliability and latency constraints, the 5G cellular standard stipulates a protocol called Time Sensitive Networking (TSN) that is an upgrade over ethernet switching on wired networks. TSN switches are much faster than the switching equipment used on 4G deployments, they are also synchronized, and centrally orchestrated.
Currently, many commercially marketed, transitional implementations are 4G/5G hybrids (mainly using 5G New Radio and 4G CORE) which cannot fully leverage the value of 5G as the existing infrastructure does not uphold the above standards. However, primarily led by hybrid technologies, strong growth in 5G infrastructure is being predicted across the globe in the 2020s.
A Spectrum of Healthcare Solutions Will Be Enabled by Optimized Network Slices
Network slices are customized, parallel-running networks that share a physical data transport infrastructure and are centrally orchestrated. The underlying infrastructure could range from optical fibers to microwaves. Prominent examples of network slices are the generalized 5G use cases illustrated in the table below. Healthcare application examples are provided for individual network slices and their combinations. Healthcare use cases shown below were prioritized by the World Economic Forum with a view to their overall benefit to society.
Healthcare’s Path to 5G Transformation
Transformative Impact of 5G: In addition to healthcare delivery, 5G technology will impact the development of new drugs and medical devices by enhancing outreach and diversity in clinical trials. Smartphone-enabled apps are already being used to provide real-world data whose value has been recognized by regulatory authorities. Adding in real-time monitoring data, and ultimately, cognitive function mapping to recognize emotions, will be transformative.
Complying With Privacy and Security Laws: Potential healthcare data security breaches are legal liabilities. As such, there will be a restraining factor in 5G adoption over wireline connectivity. However, 5G is far more secure than Wi-Fi and even 4G. In all, these require a holistic approach taking into aspects such as account authentication, traffic encryption, mobility, overload situations, and network resilience; that all can be implemented with 5G.
Drivers for 5G in healthcare: Major driver for adoption of 5G in healthcare will be the promise of operational efficiencies, higher security and guaranteed performances. The rollout of 5G is expected to mature during the current decade. Of particular relevance to many healthcare use cases are customized, private 5G networks that ensure security and reliability.
Niche players, from component manufacturers to integrators, will play an important role in providing such customized 5G solutions. Large telecom providers are expected to view 5G as a high-margin growth area and also allocate significant resources toward promoting private industrial and healthcare network solutions.
Key References
Peter Antall, MD, Telehealth and the Future of Hybrid Care, OliverWyman.com, Link.
Release 16 from 3GPP.
World Economic Forum, 5G Global Accelerator Programme, Compendium of use cases, 5G Outlook Series, September 2020, Link.
Our 5G Solutions, Nokia.com. Link.
Sathian Dananjayan & Gerard Marshall Raj, 5G in healthcare: how fast will be the transformation?, Irish Journal of Medical Science (7/2020).
A guide to 5G network security, Ericsson.com, Link.