For many years now, the GSMA has been the most important global industry association of mobile phone and mobile network providers. It has an intelligence unit called GSMA Intelligence, and this unit features a dashboard on its website that is counting mobile connections, including licensed internet of things (IoT) devices, worldwide. It is the overall figure and the annual growth rate that are most impressive. In early February 2020, there were more than 9.5 billion registered mobile connections around the world, and with 5.5%, the annual growth rate is more than solid.

These are figures from the 4G age. GSMA has published a new report on the Future of Devices in the age of 5G networks in January 2020, and it identifies China as the place in which this next mobile revolution will be adopted the quickest. Nearly 50% of Chinese consumers say they will get a 5G phone as soon as the service is available, compared to 30% in the US and between 15-20% in Europe. Taking a look at this closer, the GSMA survey shows that, for mobile phone customers, 5G is all about speed and coverage. Fifty-three percent say that they expect 5G to bring faster networks, and 37% look forward to better coverage. Only 27%, in contrast, expect cool new services, and no more than 23% say that 5G is about connecting new tools to the mobile networks.

5G is not only about speed and capacity

These figures are at odds with what industry experts say that 5G is all about. According to Rod Cruz, general manager healthcare solutions at AT&T Business, 5G networks will indeed be up to 100 times faster than 4G networks, and download capacity will be magnitudes higher. But during CES 2020 in Las Vegas, Cruz also said that gravitating towards speed is only part of the story: “5G has a very low latency, and it provides massive device connectivity. Both will drive significant transformation and innovation.” While conventional WiFi networks allow for 250 connections per access point, 4G can accommodate several 10.000 connections per access point or antenna. With 5G, this number goes up into the millions. In other words: The number of devices on the network will become unlimited.

What Cruz considers to be especially interesting with 5G is that it makes sophisticated Edge-Computing scenarios much more feasible: “Today, a lot of workload is placed into a central cloud. The idea behind Edge-computing is to move workload closer to the customer.” This is attractive in many industries, not least in healthcare. Cruz cited research from Gartner indicating that, by 2025, up to 75% of all enterprise data will be processed at the edge, and not in the cloud.

Imaging as the low-hanging fruit

What about 5G in healthcare? Many interesting applications are related to speed and capacity, of course, and here is where imaging immediately comes to mind: “One of the low hanging fruits is in the area of sonography and radiology,” said Frances Ayalasomayajula, an epidemiologist who is head of population health portfolio at Hewlett-Packard. Given that an average medical facility creates terabytes of medical imaging data per year, using 5G to mobilise imaging-related processes sounds straight-forward. Ayalasomayajula specifically mentioned the Regional East African Community Health (REACH) initiative of the WHO, which includes several digital health programmes: “They have the opportunity to leapfrog into 5G, and they see radiology as a big opportunity to apply 5G.”

Imaging is also what the collaboration of AT&T with Rush University Medical Center in Chicago is about. In January, Rush became the first hospital in the US to be equipped with 5G. One of the use cases that is currently being set up is moving large imaging files throughout the facility and providing mobile access to them. According to Rod Cruz, this is an area where 5G can make a real difference: “Evaluating imaging information in real-time and injecting artificial intelligence is something that requires 5G. It is a wonderful use case that we will be launching pretty soon.”

From remote coaching to AR/VR-based cognitive behavioral therapy

Beyond the transmission of large imaging files, it is hands-on healthcare training and remote robotic surgery in which 5G will likely make a difference. Hands-on training in medicine can go far beyond medical student training. For example, a highly specialised surgeon could coach less specialised colleagues remotely. The more complex the coaching scenarios, the more data points are needed, and the bigger the amount of information that the coaching system will have to deal with. What is needed here, apart from huge volumes of data, is the IoT capacity of 5G networks. Remote robotic surgery scenarios, in particular, will also benefit from an extremely low latency.

5G networks will also allow spatial computing applications in hands-on training or remote coaching scenarios. AT&T is partnering with Brainlab, a world-leading provider of robotic brain surgery equipment, in developing computer-tomography-based 3D reconstruction tools for mobile devices. Such tools will likely be educational in the first place, but a bit further ahead, they could well be used to augment actual procedures at the time they are taking place.

Finally, cognitive behavioral therapy (CBT) is a perhaps not-so-obvious use case for 5G applications in healthcare. CBT is a broad psychotherapeutic approach that, in some therapeutic areas at least, benefits from using augmented reality (AR) and virtual reality (VR). This is true for CBT-based desensitisation therapies in patients with phobias, but also for CBT-based distraction therapies in the context of end-of-life therapies. Think about meditative walks in beautiful surroundings, or about sitting at a beach and enjoying the sunset. Applications like these aim to make it easier to bear the final stages of a deadly disease by moving the mind away from the body, at least to a certain degree. In technology terms, it is high connectivity and very low latency that is needed to make CBT-based end-of-life distraction therapy as convincing and thus as effective as possible.

Are we expecting too much?

Promising as many of the aforementioned scenarios might sound, there is the question of whether 5G networks are really needed for all the applications that are presented to us as “killer applications” for 5G in healthcare. “Many needs of healthcare customers can be fulfilled today already,” said Shiraz Hasan of AT&T. A digital healthcare ecosystem, he argued during a CES 2020 discussion round, was not just about network availability, speed, and capacity, but also about proper devices, and about sound business models.

The lack of a proper business model, in other words, could well be a bigger hurdle for many healthcare-related IoT scenarios, for remote surgery coaching, or for AR/VR-based CBT applications than the lack of 5G coverage. Looked at it this way, the hype around 5G in healthcare would be just another example of a misleading discussion that exaggerates the influence of technology and underrates social, economic, and medical factors.

Are we creating new care gaps?

Another hurdle on the healthcare journey towards 5G could be money. Sarah Jones from Best Buy Health worries that 5G will inadvertently create more care gaps, since it won’t be available to everybody at the same time and in the same quality. There is a precedent. With more and more healthcare-related processes turning digital, people who cannot afford Wifi are having more difficulties in accessing certain types of medical care than people who can afford it. This gap could widen, should applications come up that will only run on 5G networks and not on its cheaper precursors.

Given that, outside of China, the 5G rollout has barely begun, discussions about widening care gaps could be considered somewhat premature. In fact, many industry insiders expect that, in most countries, the 5G rollout could take considerably longer than the 4G rollout. This has to do with tougher regulations, with Huawei and the Chinese-American trade-war, but also with more outspoken criticism along the lines of too little being known about the possible medical consequences of more powerful and ubiquitous mobile networks. Next generation mobile networks will come, but there is reason to believe that 5G won’t capture healthcare overnight.  

This article was first published in the latest edition of HIMSS Insights, Data Meets Privacy. Healthcare IT News and HIMSS Insights are HIMSS Media publications.