Paging Hospital Techies: You Have Bigger Worries Than White Spaces

CNET has this story about how “Hospital Techies” (notably medical monitor manufacturer GE) are worried that white spaces devices will mess up their medical systems.

Bluntly, “hospital techies” have bigger problems. As the CNET article observes, but lightly passes over, some unknown number of hospitals are using legacy medical monitoring equipment that will stop working after the digital transition. So while the odds of white spaces devices (WSDs) interfering with actual medical equipment on the approved set aside, Channel 37, approaches zero, and WSD interference with legacy equipment is equally unlikely, we may face a total meltdown in poor hospitals of medical monitoring equipment.

Rather than waste time on white spaces, I would say manufacturers like GE Healthcare need to start working with the FCC (and Congress) to engage in a massive education and outreach effort equal to what the FCC has done with the NAB and retailers to educate the public. That means stop selling any legacy equipment, require manufacturers to notify customers that have legacy equipment that it may stop working, and find out how many hospitals are likely to lose medical monitoring equipment after the DTV transition happens. A little funding from Congress to help poor hospitals that can’t afford to upgrade wouldn’t hurt either.

But worrying about white spaces is like worrying about whether a candle will blow over when a brush fire is bearing down you. Unless folks wake up to the danger, we may get seriously burned.

More analysis below . . .

Some Heart Stopping Background

As always, it is useful to think about why we are in the fix we’re in. It helps to remember that the digital transition has actually been going on for a long time, even if most people didn’t notice until recently.

In 1997, the first full power DTV station went on the air in Dallas, TX. It immediately fried the wireless medical monitoring devices in the area. For years, hospitals legally used low-power devices in the TV bands to monitor patients — because wireless is much better than having a gajillion wires trail off you and because only stuff in the TV band will penetrate the thick walls most hospitals have.

Once the problem was discovered, the FCC moved pretty quickly. It set aside Channel 37 for wireless devices and stated it would clear that channel of television stations as part of the general reshuffling of TV stations that accompanies the DTV transition (remember, we’re moving TV stations around, that’s how we cleared off channels 52-69 to auction). But, in the late 1990s, no one knew when the DTV transition would happen. Congress did not pick a “hard deadline” until 2005. Back in 1998-99, when the FCC conducted this rulemaking, the transition was scheduled to occur gradually. So rather than require the medical community to migrate on a particular schedule, or ordering the manufacturers to stop making equipment that works on other frequencies, the FCC left it to the discretion of the manufacturers and the hospitals. Given that no one knew when the transition would occur, why force hospitals to buy expensive equipment on what might well turn out to be an artificially accelerated schedule?

And so the matter sat. Manufacturers gradually changed over their equipment, but no one knows when all manufacturers converted all their equipment (if they have) or when the last units that work on channels other than Channel 37 were sold (or if they are still being sold). And cash-strapped hospitals did what cash-strapped hospitals do — try to make equipment last and defer expensive upgrades.

So as of today, to the best of my knowledge, no one has any idea how much legacy equipment is out there. We may be looking at a huge problem, or a relatively minor hiccup. Worse, no one is responsible for knowing. Unlike the digital TV transition, where policymakers have spent the last year grappling with how to inform consumers, the FCC has mandated all kinds of labeling requirements for retailers, put deadlines on manufacturers to include digital tuners, etc., etc., no one has any responsibility to inform hospitals about the problem. Manufacturers can keep making equipment that works on other channels, and vendors can still sell legacy equipment that may stop working when we flip the switch on the conversion in ten or so months.

This past December, I went with my wife to the Annual Mid-Year Convention of the American Society of Health-System Pharmacists (for some reason, “Mid-Year” occurs every year in December, whereas “Annual” occurs every year in June; I assume there is some deep pharmaceutical reason for this). As I strolled the vendor floor, I stopped at every wireless vendor I could find and asked if they had any information on the compatibility of their equipment with the digital transition. Every single one of them said: “Huh?”

I am not reassured by this experience.

So What Do We Do Now

So now we have a problem. Some unknown number of hospitals are using wireless monitors that are likely to get fried on February 17, 2009 when we shut down analog and go entirely digital. That represents many millions of dollars in equipment upgrades for hospitals that probably can’t afford it. To make matters worse, most of these hospitals probably have no idea that this is on the horizon. And no one has any responsibility to deal with this mess.

Which is an important point to remember. This isn’t actually anyone’s fault. Unlike the problem with wireless microphones, where some manufacturers have knowingly been selling their ware to unauthorized users, the manufacturers here have played by the rules. Ditto the retailers. This simply fell through the cracks, because the FCC thought it took care of the problem ten years ago and events just kind of puttered along on their own power with everyone minding their own business and no one responsible for generally minding the store.

Mind you, this is not necessarily a crisis — assuming we actually tackle this as a serious issue. That means the FCC, Congress, the device manufacturers, and various medical organizations — such as the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) — need to focus on this and develop a plan similar to the one used to inform consumers about the upcoming transition. This will include:

1) Find out the scope of the problem. This is a relatively small market, as things go. The manufacturers or retailers can probably give some estimates on how much legacy equipment is out there based on sales records. Or the FCC can work with JCAHO to send notices to all accredited hospitals.

1a) It would also be nice to know if this stretches beyond hospitals. Is this equipment used in hospices, rehab clinics, or other health-related institutions? Is there a significant secondary market in used equipment, so that legacy equipment remains in circulation even after a hospital upgrades?

1b) This would be an excellent opportunity for a Congressional hearing to draw attention to the issue and gather some information.

2) Next, the FCC needs to take some preliminary steps to set up a time table and require notice similar to what it has done on the consumer side. For example, it is probably worth it for the FCC to prohibit further manufacture of equipment that works on channels other than Channel 37 (if such is still being made), and either prohibit further sale of such items to require notice that the equipment may not function after February 17, 2009 (just like it required for television retailers). The FCC should also require the manufacturers and retailers to send out notices to customers regarding which models will function after the transition and which may not.

3) The U.S. Food & Drug Administration (FDA) also has a role here, as these are regulated as medical devices. It should participate in any educational campaign, and may wish to consider whether to require recall of devices that will stop working after the transition.

4) Finally, it would be nice if Congress would authorize some money to help hospitals upgrade. After all, the “digital dividend” in the form of spectrum auction revenues was over $19 billion. Congress could (and should) authorize a few hundred million of that to help hospitals replace legacy equipment. Heck, Congress gave every consumer $50 for a set of digital rabbit ears. I think making sure medical monitoring equipment doesn’t get fried is worthy of the same investment.


The white spaces stuff is pretty small potatoes compared to the overall problem here. We have ten months to fix it, which should be enough time if we take the issue seriously. This isn’t a crisis, but it will take some immediate and concerted action to keep it from being a crisis. That requires leadership and cooperation among all the key stakeholders, the FCC, the FDA, and Congress.

Stay tuned . . . .


  1. From the viewpoint of an old TV guy…

    First off, ‘fried’ is the wrong word to use to describe what happened to the heart monitors. “Jammed” is a much better word to use. A digital TV transmitter looks like a powerful static generator filling up its assigned chunk of bandwidth. It doesn’t DAMAGE the heart monitor transmitters and receivers; but it overpowers the puny battery-powered signal for as long as the TV transmitter is on. Unfortunately for hospitals, TV transmitters tend to be on 24/7 these days — exactly the same hours the hospital wants the heart monitors to work. (When the Dallas hospital and station figured out what was going on, the DTV transmitter was turned off — temporarily — and the heart monitors started working again — temporarily.

    The villains here, imho, are the device manufacturers. Look at the rules in effect when they decided to go with unlicensed operation on ‘unused’ TV channels — very roughly:

    1) The manufacturer must get his circuit design blessed by the FCC and swear blind to follow the rest of the rules.

    2) If the unlicensed stuff interferes with licensed signals, the unlicensed stuff gets shut down. Immediately.

    3) If a licensed signal interferes with your unlicensed one you have the right to throw your stuff in the nearest trash can.

    They’re tough rules! It’s like the water utility along a stream in the desert southwest signing a deal with its upstream neighbors that it’s entitled to whatever water the factories and farms don’t use. When you turn on your tap one morning and nothing comes out you are entitled to, that’s right, NOTHING.

    So why would someone making heart monitors — life and death stuff — sign on to such a deal? It sounds goofy to me. Police and fire departments, which want to keep in touch with their units, go to the FCC and get a license. Ma Bell, back in the days when getting a long distance call across the country required erecting microwave towers every 20 miles or so, went to the FCC and got stacks of licenses. Likewise for construction companies, taxi operators, and yes, radio and TV stations.

    Harold, you’re saying that folks like GE Healthcare are ONCE AGAIN picking bandwidth that will PROBABLY work (90% of the time)??? It makes my heart stop.

  2. Rich:

    Thanks for the clarification on the interference. On the “should we blame someone” question, I have to disagree about the manufacturers. While they operated under Part 15 rules for interference, it made sense because this was in the vacant channels in the broadcast band, operating at low power, and on premises controlled by the user. Interference was therefore extremely unlikely.

    The problem here is that this little application fell through the cracks. It was never anyone’s job to track it or organize an education campaign. In that sort of situation, people just drift along. Now we need folks to step up and take responsibility before this migrates from a problem to a BIG PROBLEM.

  3. What magic event happens on the cut-over that causes things to break that hasn’t ALREADY happened?

    DTV stations all over the country have been turning on for years. On the cut-over date, the old analog stations will turn off. Turning off a station isn’t going to have any impact.

    As each station turned on it’s new DTV signal, it would have impacted immediately.

    Or is there some large number of stations that are waiting until the cut-over date to stop analog and start digital all at the same time?

  4. 1) For all I know, it is already happening in some places, although if it were I would imagine we’d have heard.

    2) This is another one of these “we’re dealing in probabilities and cumulative effects” issues that makes spectrum so much fun. As more stations convert to digital, the interference grows. After the transition, the interference will be at maximum.

    The FDA has a good general article on interference management here:

    The article is not about the DTV transition per se, but discusses a number of interference issues including the DTV interference problem.

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