2G GSM Sunset:

What do IoT / M2M

Healthcare Providers do Now?
WHITE PAPER
IN THIS PAPER: IN-HOME HEALTHCARE NOW IS RECOGNIZED
Lorem ipsum dolor sit AS A VITAL WAY TO DELIVER COST-EFFECTIVE
amet, consectetuer SOLUTIONS TO PATIENTS WITHOUT
adipiscing elit, sed diam
nonummy nibh euismod.
COMPROMISING SERVICES.
Sed diam nonummy
This shift helps alleviate the constant (and often conflicting)
nibh euismod tincidunt
ut laoreet dolore magna pressure to reduce costs, improve the care offered, and reach larger
aliquam erat volutpat. populationsall at the same time. A major component of this trend
involves Internet of Things (IoT) and Machine-to-Machine (M2M)
Ut wisi enim ad minim
veniam, quis nostrud communications. IoT / M2M technology enables transmission of data
exerci tation corper. from patients to doctors via in-home devices that monitor a variety
of conditions, such as diabetes, cardiac arrhythmia, medication
Lobortis nisl ut aliquip
ex ea commodo.
adherence, and Alzheimers disease.

Many in-home care solutions network in America useless. Other

incorporate Personal Emergency
Response Systems (PERS) that let
users call for help in an emergency
simply by pushing a button, or in
the case of Alzheimers patients, by
an automatic notification using GPS
location technology. Traditionally,
PERS solutions have included a radio
transmitter, a console connected
to a telephone, and an emergency
response center that monitors calls.
Today, however, landline telephone
setups have been replaced by cellular
communications technology.
These solutions traditionally utilized
low-cost 2G GSM connectivity, and
this has caused major headaches for
IoT /M2M healthcare providers. After
years of announcements and warnings,
AT&T shut down (sunsetted) its 2G
service at the start of 2017, rendering
any IoT-based 2G devices on their
providers, such T-Mobile and Verizon,
took up the slack and offered IoT / M2M
healthcare providers a lifeline, albeit
temporary virtually all 2G support
in the United States will be gone by
2019. In the rest of the world, 2G still is
very popular and will remain so for the
foreseeable future, especially in rural and
developing areas.
The reason AT&T, and ultimately every
other carrier, is sunsetting 2G is simple
they need the space. Eliminating 2G
enables the providers to refarm their
valuable spectrums for 3G and, more
importantly, 4G LTE technologies that
are proving increasingly vital with the
unceasing growth of IoT worldwide.
This white paper examines the history
behind this dramatic shift, and examines
how IoT/M2M healthcare providers can
succeed in an era without 2G.

2017 AERIS COMMUNICATIONS, INC. 2

WHAT LED TO THE SUNSET OF 2G?
The answer to this question requires a more in-depth understanding
of cellular technology and the issues that have driven the industry for
the past few decades.
The analog AMPS
sunset in 2008
In the 1990s and early 2000s, the
IoT / M2M industry deployed analog
Advanced Mobile Phone Service
(AMPS) cellular devices for many
data transmission applications. This
was fine until customers discovered
smartphones (and their ever-growing
data needs). Only all-digital cellular
services could meet bandwidth
demands. Soon the advanced analog
devices were outdated and underwent
an AMPS sunset as carriers began to
transition to digital cellular.
Concurrently, in February 2003, the
Federal Communications Commission
(FCC) weighed in on the issue and set
an AMPS sunset date for America.
Customers using AMPS had five years
(until February 18, 2008) to migrate
to digital cellular, and carriers were
required to support the old technology
until that date.
The digital age
When North American carriers
initially deployed digital cellular, they
chose technologies with dissimilar,
incompatible coding and data
protocols. Some carriers chose Code
Division Multiple Access (CDMA)
cellular. Others selected Global System
for Mobile (GSM) cellular (after first
deploying ANSI-136 TDMA1). As
a result, IoT / M2M customers now
had two basic packet-data service
choices2G CDMA 1xRTT or 2G
GSM General Packet Radio Service
(GPRS) networks.
The automotive and trucking
industries, major players in IoT / M2M,
chose CDMA for the higher data
throughput and for easy roaming
into analog AMPS still common
in rural market areasANSI-95
CDMA radios fully supported AMPS
mode. More importantly, vehicle
design and production cycles drove
a requirement for service longevity.
This made CDMA the best choice for
reliability and robustness.
Unfortunately, CDMA radios were
more than twice as expensive as
GSM radios, making them a non-
starter for many cost-conscious
industries, such as healthcare. That
made 2G GSM GPRS the obvious
choice for healthcare as a whole,
as the lower cost of radios was too
enticing to ignore. As a bonus, the
simpler GSM protocol technology,
combined with the scale and volume
of GSM device sales in international
markets, rapidly dropped radio prices
even further.
2017 AERIS COMMUNICATIONS, INC. 3
SMARTPHONES CHANGE
THE PLAYING FIELD AGAIN
With the advent of the Apple iPhone, social media, and other drivers,
smartphones suddenly took a more important, if not central, role in
peoples lives. Soon it was no longer enough to call and text. Both
business and personal users demanded video sharing, live chats, GPS
navigation, and a host of other gotta have it features and packet-
data use skyrocketed. This put tremendous strain on the existing cellular
infrastructure. Companies were forced to deploy more spectrum-
efficient protocols and acquire more spectrum to boost capacity.
These are the changes that ultimately doomed 2G in America.

Where did everyone go?

Customers who relied on CDMA were
safe as these packet-data protocols
offered higher spectrum efficiency and
there was little pressure to revamp
their operations. Users had time to
deploy 3G EV-DO solutions, which
could co-exist with 1xRTT in the same
spectrum bands. This gave handset
customers an easier migration path
to faster performance without any
disruption in service or quality. In fact,
the completed deployment of 3G
networks has enabled CDMA providers
to expand into advanced WiMAX and
4G LTE solutions, further enhancing
the customer experience.
However, GSM carriers who chose
2G GSM have had to deploy Universal
Mobile Telecommunications System
(UTMS) 3G technology in new
spectrum bands. UMTS uses a wide-
band CDMA (W-CDMA) protocol that
is incompatible with the Time-Division
Multiple Access (TDMA) protocol
of GSM and cannot co-exist in the
same spectrum. This has hindered
3G expansion and carriers have had
to employ multiple steps (HSDPA,
HSUPA, HSPA, HSPA+, and others)
to achieve their goals. As a result,
healthcare GSM customers are less
likely to have access to WiMAX and
LTE, at least in the near term, than
their CDMA counterparts.
How efficient are all these spectrums
over the traditional 2G GPRS networks?
2G CDMA 1XRTT is 3.6 times
and EV-DO is 34 times more
spectrum efficient.
Newer HSPA+ and 4G technologies
are 120 to 230 times more efficient.
And with the data explosion of IoT
devices engulfing every industry,
more spectrum efficiency is absolutely
desired, if not required.

2017 AERIS COMMUNICATIONS, INC. 4


Replace with
3G HSPA devices
Device suppliers are making 3G HSPA
devices more readily available. However,
the HSPA coverage footprint is much
smaller than GPRS and, in many markets,
HSPA will be swapped for LTE (see
below). The inevitable migration to LTE
would likely be cost and feature overkill
for most healthcare applications. That
being said, experts estimate the HSPA
sunset will not be complete until well
after 2020.
Replace with 2G CDMA
This is the best option for most IoT/
M2M in-home healthcare applications.
2G CDMA service was never affected
by the AT&T initiative, and carriers have
committed to 10+ years of service
longevity making it theoretically more
viable than 3G HSPA for the foreseeable
future. Plus, 1xRTT coverage in the U.S.
THERE ARE CHOICES,
BUT WHICH ONE IS RIGHT?
Obviously, if you are (or were) an
AT&T 2G customer, you already have
made the transition to another network
solution AT&T kept its promise and
sunsetted 2G at the beginning of January,
2017. If you migrated to a competing
2G solution, such as those offered by
T-Mobile or Verizon, ultimately you will
have to migrate again prior to 2019. Given
this deadline, there are a few valid options
you should consider for future growth.
already is significantly better than GSM / is not yet sufficient for nationwide
GPRS, with more carriers, such as Sprint, deployments. More important, the
adding 2G CDMA coverage. spectrum fragmentation for LTE means
that current generation LTE radios are
Given the lower cost of 1xRTT radios single-band in nature dedicated for
and the large number of deployed 1xRTT use on a single carrier in LTE mode.
applications in many leadership This is too restrictive given that
industries, like automotive and trucking, deployed units can never be moved
using 1xRTT for IoT / M2M applications from one carrier to another.
makes sense. In particular, most healthcare
IoT / M2M applications simply do not need However, multi-band LTE radios are
the high throughput and higher radio cost beginning to emerge, at a slightly higher
of 3G HSPA and 4G LTE technologies. cost, and this, eventually, will remedy
the issue. But is it worth paying more
for technology you dont really need (but
Replace with 4G LTE offers a clear future path)? Essentially,
Deploying LTE devices is not really the top American carriers have not yet
practical for many healthcare IoT / settled on LTE roaming agreements.
M2M applications. The radio costs These will take time to complete and
are very high generally 4 to 10 deploy, and these timetables arent
times more expensive than 2G GSM helpful when you need to determine
and 2G CDMA radios. And coverage your network infrastructure today.
2017 AERIS COMMUNICATIONS, INC. 5
WHAT DOES THE FUTURE HOLD?
As an IoT/M2M healthcare provider in the American
market, you are stuck between a rock and a hard
place. Cellular technology changes and product
lifecycles are shorter and more disruptive than ever
before. You need your devices to operate for many
yearsunlike consumer handsets and smartphones.

The key is to incorporate tremendous forethought in all

product design and deployments. Consider how to set it
and forget it in an era of constant flux. For example, make
a radio technology change as easy as a battery change
by incorporating a plug-in adapter or sled for the device
radio. This could allow hospitals and clinics to update their
equipment simply and quickly, minimizing (or eliminating)
the need for expensive truck rolls.

Another major factor in navigating the ever-changing IoT / M2M

landscape is to find the right partner. At Aeris, our mission is
to find the best solution based on your unique requirements,
not to promote specific wireless technologies. We offer your
operation (regardless of size) an array of options for IoT / M2M
deployments for healthcare, including 3G HSPA, 2G CDMA,
and 4G LTE. And since we are a leader in global IoT / M2M
solutions, we have our pulse on where the industry is going
and what it means for your future success.

For more information on Aeris health solutions, call

1-888-GO-AERIS (1-888-462-3747) in North America
or +44 118 925 3202 in Europe. You can also write to
info@aeris.com or visit aeris.com/industries/healthcare.

2017 Aeris Communications, Inc. All rights reserved. No portions of this document may be reproduced without prior written consent of
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2017 AERIS COMMUNICATIONS, INC. 6

ABOUT AERIS:
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2017 AERIS COMMUNICATIONS, INC. 7