Leroy Jones, Jr. is the creator of Talking Technology with Leroy Jones, Jr.

mHealth: Apps & HIPAA

mHealth: Lifeline Future

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FCC Commissioner Mignon Clyburn nailed it: 


Lifeline has remained unchanged for 30 years. We need to retool, update and future proof this program, while preventing fraud.

Mignon Clyburn tweet

January 21, 2016


Commissioner Clyburn tweeted this after last month's appearance at MMTC's Broadband and Social Justice SummitThat event focused on the crucial links connecting broadband adoption with empowerment and social equality.


MMTC and Commissioner Clyburn each deserve praise for their efforts not only to draw attention to broadband adoption but also for highlighting an obvious solution: reforming the FCC's outdated Lifeline program, which offers phone service discounts for low-income consumers. 


As Commissioner Clyburn noted, Lifeline's goals are noble but the program itself has become ridiculously outdated. Its focus is entirely on phone calling instead of Internet service.  Moreover, even granting changes in 2005 to include pre-paid wireless calling, the program still focuses on "solving" problem that for most people hasn't existed in a decade or more


Free phone calls and free texting long ago became staples of wireless service. On the wired side, bundles of broadband and entertainment services have for years included unlimited calling as a free add-on. 


Yet Lifeline soldiers on with an outdated emphasis solely on phone calling. Fraud is a problem and by ignoring broadband adoption, the program effectively undercuts efforts to promote health care, education and social justice.  (For more on the health care implications, see my Dec. 4 entry, "A lifeline for mHealth.")


The way to modernize Lifeline is obvious, particularly given the growth of discounted bundled services: allow the program's funds to be used for fixed or wireless broadband Internet service. A coordinated enrollment process managed by state agencies instead of providers would play the key role in determining eligibility for Lifeline.  This approach will make Lifeline more efficient and reduce fraud.


Most important, it will give low-income consumers what's they truly need in today's society - an Internet link to opportunity, health care and a better life. Average broadband speeds in the U.S have tripled since early 2011 so today's access should be easily sufficient for most needs.


Technology and consumer preferences have both changed radically since the Lifeline program was created over three decades ago.  It's time that Lifeline changed too.



mHealth & Rural Health Care

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Tech writer Mark Jamison at AEI's Tech Policy Daily recently offered an interesting proposal for federal regulators this year:


"Net neutrality has become an illusion in that its rhetoric leads to the appearance of giving customers greater opportunity and controlling market power. The reality is that it is keeping the poorest and most economically vulnerable among us from getting the services the rest of us take for granted. Let's resolve to stop this."


The overlooked impact of last February's FCC vote to begin micromanaging the Internet with 1934 "Title II" rules is that it hits hardest on society's disadvantaged. First, they're less likely to have broadband service.  Second, they have the greatest needs since broadband gives them access to services such as mHealth, and telehealth that they're less likely to have elsewhere.


The FCC's decision to saddle broadband technologies with Title II rules directly undercuts our ability to deploy high-speed broadband.  Therefore it also directly undercuts any effort to expand health care access. 


The latest evidence of these problems came last Tuesday, as an Arkansas Internet provider told Congress how the FCC's action had forced her company to delay plans to deploy across Central Arkansas. Elizabeth Bowles, head of Aristotle ISP, testified, "Before [the FCC's action], it was our intention to triple our customer base by deployment of a redundant fixed wireless network...." But the firm had to pull back because of what she called "the risks [and] expense" of complying with the FCC's rules.


So tens of thousands of residents in Central Arkansas lost a broadband option that could have linked them to quality health care access.


To put this in perspective, consider the health care challenges faced in that state.  Arkansas ranks 48th in overall healthcare, according to a 2015 surveyNearly 40% of rural residents are obese, and there is a growing health disparity among the less educated.


Nor is Arkansas alone in these problems. Rural healthcare access remains a crucial issue across much of the U.S., particularly in areas without public transportation.  A 2013 study found that transportation barriers limit health care access, especially for those living in lower income communities.  These individuals are more likely to miss appointments which leads to delayed care and an inability to properly manage chronic illnesses.


Telehealth and mHealth will not solve every healthcare problem. But they can solve many - and at an affordable cost. 


The FCC should stop undercutting online health care access - and broadband deployment in general - in a misguided attempt to regulate the Internet.




mHealth: Hospitals Off Target?

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A Lifeline for mHealth

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"Computers and the Internet are on the cusp of making health care more personal, consumer oriented, cost effective, innovative, agile, and entrepreneurial."

That's the theme of a new report on America's emerging revolution in health care services. Dismissing the current health care system as "closed and stagnant," the report explains how improvements in computing and broadband power will radically improve health care quality for everyone.

While this vision, particularly as it relates to mHealth and smartphones, is on target, there's unfortunately one part of the revolution he overlooks: those unable to afford high speed Internet access.

That fact highlights an increasingly obvious shortcoming of the FCC's program offering telephone service discounts to low-income citizens. Called Lifeline and funded by the Universal Service Fund, this program has noble goals. But it has unfortunately become as outdated as the sole method of communication it helps provide for consumers.  

In today's tech-dominated, Internet-focused world, Lifeline only makes phone service, not Internet access, more affordable.  

Yet phone calls increasingly don't meet consumers' needs.  According to Nielsen, 31% of U.S. mobile users say their voice calling usage is "low." Year over year, calling minutes decreased for those in the 25-34, 35-54 and 55+ age groups, while reliance on Internet-based methods of connecting, communicating and accessing information are on the rise.

That 55+ group is especially important since they are the largest consumers of health care services and therefore could benefit the most from improved mHealth access.

FCC Commissioner Mignon Clyburn outlined principles that would modernize the Lifeline program to better meet the needs of today's consumers. These include covering both fixed and mobile broadband so that consumers can access and benefit from modern health care services online.  Additionally, to resolve ongoing inefficiencies and fraud that occurs in the existing program, providers would no longer determine eligibility of Lifeline participants. Instead, state governments would share the responsibility.

Lifeline's modernization shouldn't be a question of "if," but "when." And given the rapid fall-off in funding, the answer should be "now." Between 2012 and 2014, Lifeline's funding dropped more than $600 million (25%). The FCC does not have the luxury of pushing reforms to the next Administration.  A continued plunge in program funds would, by 2017, become truly catastrophic to the program and the consumers who depend on it for access.

The FCC needs to update Lifeline to reflect Commissioner Clyburn's core principles immediately.

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