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Strictly private and confidential 5G in healthcare How the new wireless standard can connect a post-COVID healthcare ecosystem2 PwC 5G in healthcare In a hospital ward in Wuhan, China at the peak of the COVID-19 pandemic in the city that was the epicenter for the global outbreak 12 robots glided across the floor. Their primary tasks: taking patient temperatures, delivering meals and disinfecting the facility. More than just an advance in automation, these robots were saving lives. Ill patients received much-needed attention, and healthcare workers were afforded distance from the contagion and a safer ward to work in. Easily lost in the details of the story of this eye-popping, unique healthcare automation is the telecommunications breakthrough that made it possible; namely, a 5G network, the next generation of wireless communication technology. Without the significant speed, reliability and quality of 5G, managing a fleet of robots to do such intricate chores would be out of the question. But perhaps more important, this innovation hints at the ways 5G networks could transform and improve all of the critical components of healthcare, a subject especially meaningful today as the spread of the coronavirus has put unprecedented stress on healthcare systems around the world. 5Gs features could prove valuable in many areas of healthcare, including telehealth, remote surgery, transferring large medical files, tracking patient movements inside facilities, using wearable devices for real-time monitoring, and delivering continual treatment information and support to patients. In short, 5G promises to provide essential levels of connectivity to enable a new health ecosystem one that can meet patient and provider needs accurately, efficiently, conveniently, cost-effectively and at substantial scale. Executive summary3 PwC 5G in healthcare possibilities 5Gs remote The potential of 5G springs from the fact that its technical attributes represent a quantum leap forward from its predecessor, 4G. 5G is capable of achieving speeds approximately 100 times faster than 4Gs while also handling vastly more connections. And these advantages are strengthened by ultra-low latency, the time it takes for the network to process a request. In assessing the impact that 5G could have on healthcare, its important to keep expectations in check. For one thing, widespread implementation of 5G is still some ways off. Although there are pockets of 5G installations by telecom companies in all of the largest countries, the availability is generally limited to small cell zones in urban areas. Extensive deployment is not expected until about 2025 in many developed markets. In addition, broad consumer acceptance of 5G applications like wearable medical devices and telemedicine is unlikely to occur in the next few years, though the COVID-19 pandemic has probably accelerated this timeline significantly. And with how sensitive and confidential medical data is, concerns about security and privacy are already being raised about healthcare records being transferred across enormous, often global public networks. In the context of the COVID-19 pandemic, much attention has focused on 5Gs potential to support telehealth services, or doctors visits conducted via computer, which are helpful when physical distancing is required or when patients are located far from healthcare facilities. Basic, one-on-one, low-touch sessions are already feasible over existing 4G and fixed broadband infrastructure. But 5G offers the potential of moving these interactions a big step forward by, for example, adding sensors and virtual4 PwC 5G in healthcare reality to teleconferencing, enabling healthcare workers to remotely monitor vital signs during calls. In addition, because 5G can transmit sizeable data packages, testing patients with conditions for changes in their heartbeat, blood sugar and blood pressure multiple times a day using cloud-linked scanners is also possible. These advances, in turn, would unlock more insights into the day-to-day health of patients. As in other sectors, including transport, manufacturing and retail, combining and integrating 5G with a wide array of other advanced technologies AI, the Internet of Things (IoT), the cloud, big data analytics, geolocation sensors, real-time monitors is essential for healthcare to apply the full potential of 5G. 5Gs technology specs far surpass those of other wireless protocols Source: PwC Real-time high-capacity, low-latency applications Feature Description Wi-Fi6 4G 5G Latency Delay between the sender and receiver of the data the lower the latency, the more real time the experience of the event 20 milliseconds (ms) 3050 ms 110 ms Reliability/availability How efficient the network is in transporting data between the source and destination without packet loss 99.99% 99.99% 99.99% Throughput Theoretical maximum amount of data moved from one place to another in a given period 9.6 Gbps 300 Mbps 1 Gbps 10 Gbps Speed (project driven) Expected practical speeds per user or device 1 Gbps 2050 Mbps Up to 1 Gbps Connection density Number of connected devices per unit area 8 per part 12 per part 100 per part Energy Comparative power consumption levels Medium High Medium5 PwC 5G in healthcare 5Gs impact on the healthcare value chain The benefits of 5G will be felt differently by each of the key participants in the healthcare value chain: providers, payers and pharmaceutical companies. But on the whole, 5G networks hold out the promise of major improvements in efficiency and outcomes, positive results that ultimately feed through to patients. Providers The onset of the COVID-19 crisis exposed a flaw in the operations of many healthcare providers including hospitals and local/regional health authorities who found themselves at the eye of the storm: manual inventories of devices. As the anticipated need for ventilators and other emergency devices grew, hospitals were scrambling to figure out whether they would have sufficient equipment to deal with the expected crush of seriously ill patients. In many cases, device inventories were not electronically tagged, and manually maintained lists were ragged at best. Hospitals have generally resisted sophisticated inventory monitoring systems because their tight profit margins make them loath to earmark expenditures for new computer systems and training that could upgrade efficiency but not generate a tangible return on investment. But 5G could do much more than just track equipment. 5G-enabled devices could also monitor vital variables such as bed occupancy levels, as well as the movement of people physicians, nurses, patients around the hospital. These insights could then be integrated into the hospitals electronic medical records (EMR) system, making it possible to visualise and manage hospital activities with unprecedented clarity and granularity. The resulting visibility would provide the basis for highly effective operational improvement initiatives. In perhaps a more futuristic vein, 5G technology could change the face of how providers deliver medical care and alter the relationships between patients and doctors. Telehealth, which we are just beginning to6 PwC 5G in healthcare harness, will in time be routine. And it will be amplified by the use of wearables. Remote monitoring via wearables, 5G networks and cloud analysis and processing has been termed the Internet of the body. A further 5G opportunity for providers is so-called remote operations. Although video demonstrations of surgical techniques and broadcasts of operations via fast-speed 5G networks are already viable, the real breakthrough will come with the emergence of the tactile Internet. Enabled by the ultra-low latency of 5G, the tactile Internet would enable a physician to perform a procedure on a patient who is in a different location. The surgeons movements at one site would be recreated instantaneously by computerised equipment at the other site, an innovation that could particularly benefit patients in rural areas or smaller regions, where surgeons specialising in complex procedures may not be readily available. Payers 5G-networked wearables can also be a boon for healthcare payers whether they are a private insurance company or a government. Payers have large financial incentives to keep their individual clients healthy and to catch medical emergencies early so they can be treated before the situation requires outsized and expensive diagnostic tests and treatments. Expanding the use of wearable monitoring equipment to, for instance, more diabetics or patients at risk for cardiac issues could save lives, improve the health of the general population and cut payer outlays significantly. As the price of setting up 5G connectivity declines, it will become feasible for health plans to provide monitoring devices to every policyholder whose health outcomes (and costs) could be improved by such equipment. Payers will also benefit from the substantially increased speed and bandwidth available on 5G networks, compared to current telecommunications systems, inasmuch as these capabilities enhance the treatments that physicians can employ leading to better patient outcomes. For instance, in many cases, MRI scans and other critical images must be sent to a specialist for review, a transmission that can take a long time or even fail if the network is not equipped to handle large files the way 5G can. As a result, diagnoses could be slowed and compromised and treatment delayed, ultimately adding significant costs to the physician patient interaction that will be borne by the payer. Similarly, 5G can enable advanced technology-assisted treatments that have been shown to improve outcomes and potentially lower costs associated with individual cases. One illustration: augmented reality (AR), virtual reality (VR), AI and robotic equipment linked to large databases and sensors can aid in complex operations by offering surgeons visibility that they may not have otherwise and by recommending procedural steps based on the latest accumulated medical knowledge. Pharmaceutical companies Clinical trials greatly depend on a constant flow of data detailing patients responses to the therapies under investigation. In some cases, the participants in the trial take their own vital signs every day and self-report them via a website. In others, they go into a doctors office or hospital for diagnostics. 5G infrastructure and connectivity may now provide drug manufacturers with the incentive and opportunity to place IoT-connected monitoring devices in the participants homes during clinical trials. This would reduce administrative overhead and processing costs, in turn bringing down the price of each trial and enabling pharma companies to trial more drugs each year. And the availability of the data in real time might shorten the cycle time of a trial from, say, eight months to six, meaning the company can get the drugs to market faster or more quickly halt trials that arent working. Expanding the use of wearable monitoring equipment to, for instance, more diabetics or patients at risk for cardiac issues could save lives and cut payer outlays significantly7 PwC 5G in healthcare A new health ecosystem As use of 5G in healthcare increases, with its applications boosted by advances in robotics, IoT and AI, a new connected healthcare ecosystem will take shape. In our view, this ecosystem will align with a relatively recent idea known as 4P medicine that is, it will be predictive, preventative, personalised and participatory. Predictive Equipped with a constant flow of instantaneous data on patients vital signs and relevant alerts, blended with information on lifestyle behaviors and social factors, the new health ecosystem will be better able to predict risks to patients. Simultaneously, it will furnish healthcare providers with early warnings of patients problems. In turn, physicians and nurses can use these insights to intervene or respond effectively before the problem escalates. Although 5G wont be central to the predictive process itself, it will underpin the ubiquitous connectivity and scale of the ecosystem that collects, analyses and shares the data. Preventative Being predictive boosts the ability to take preventative action. An apt example especially relevant in the context of the COVID-19 outbreak is the ability to track and trace with unprecedented accuracy the location and proximity of vast numbers of people using smartphone apps, as evidenced in South Korea. During a contagion, this geolocation data can be combined with diagnostic profiles and ongoing testing results to pinpoint factors like who is most at risk and who may be unwittingly passing an as-yet asymptomatic illness on to other people. Individualised alerts and interventions to stifle the spread of the outbreak can then be initiated.8 PwC 5G in healthcare Personalised The combination of constant real-time health monitoring over 5G networks will provide substantial opportunities for personalising peoples healthcare experiences and interventions. Care providers can use the tactile Internet, for example, for remote examinations of patients who are unable to get to a large clinical facility that specializes in their condition. In addition, well-being advice can also be tailored and delivered to the individual, confidentially, at a population-wide scale. Participatory In the 5G-enabled health ecosystem, patients will become less passive consumers of healthcare and more engaged participants in driving their own outcomes. Currently, the average patient in the US spends about 15 hours a year with a healthcare provider, but has more than 5,000 waking hours to care for themselves. By activating some of those 5,000 hours that is, taking independent actions to manage their well- being, diagnostics and treatments patients can improve their quality of life and medical outcomes and, at the same time, reduce overall costs in the healthcare system. One study found that after controlling for demographics and health status, an activated patient costs US$1,987 less annually than a less activated patient, a 31% difference9 PwC 5G in healthcare The privacy challenge To realise the full potential of 5G networks in healthcare settings, network security and data privacy are paramount. Nothing is more sensitive than an individuals medical records. And in order for patients and participants in the healthcare value chain to freely use, without fear of data theft, advanced communications programs for healthcare interactions and activities, the 5G networks that serve as the backbone must be protected from cyber intruders. In our view, there are three prongs to a robust and effective cybersecurity and privacy strategy for 5G networks used in healthcare: Zero-trust approach. There should be a robust security posture from end to end for all devices and software on a 5G network. Each device and application must be assessed for
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