Running head: REMOTE SURGICAL MENTORING VIA 5G WIRELESS TECHNOLOGY 1

IN SUPPORT OF UNITED STATES NAVY COMBAT OPERATIONS

Remote Surgical Mentoring via 5G Wireless Technology

In Support of United States Navy Combat Operations

Pia Francisco
University of San Diego
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IN SUPPORT OF UNITED STATES NAVY COMBAT OPERATIONS
Introduction

Clinical care environments in the United States Navy include ships, submarines, and

airplanes, as well as austere environments comprising operations that support Marines and other

warfighting units. These settings present unique clinical challenges. The present paper proposes

investment in the technological equipment and 5G cellular/wireless infrastructure required to

support real-time remote surgical mentoring in forward-deployed units and other austere settings.

Background and Assessment

Technology Overview. 5G is the universally accepted abbreviation for fifth generation

wireless technology. It affords significant improvements over 4G with speeds of up to 25 Gpbs

and extremely low latency of less than one light-millisecond (Fisher, 2019). Such speeds and

low latency are considered robust enough to support communication between self-driving

vehicles as well as augmented and virtual reality mobile applications (Segan, 2019). In

anticipation of high consumer demand for such products and services, all the major mobile

telecommunications companies have already begun operating their 5G networks in select

markets worldwide while concurrently expanding their respective global 5G footprints.

Military Background. Presently, Department of Defense (DoD) via the Defense Health

Agency (DHA) is engaged in the most extensive implementation of an Electronic Medical

Record (EMR) system in history. Built on Cerner’s Commercial Off the Shelf (COTS) EMR

platform, the solution, called MHS (Military Health System) Genesis, presents with an

approximate acquisition cost of $5.4B over the course of the implementation (Chappellet-Lanier,

2018). In addition, prior to implementation, each of the uniformed services needed to make
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significant improvements in their infrastructure to support the vast amounts of EMR data which

needed to be moved, literally at light speed, for patient care to be delivered effectively.

In response, DHA executed contracts with local and regional vendors throughout the

world to create the Medical Community of Interest (MEDCOI) fiberoptic network (Petty, 2018).

Although construction of the MEDCOI was primarily achieved to support implementation of a

modernized EMR, this was not its only benefit (Serbu, 2017). Transmission of data with

negligible lag also supported the operation of synchronous telehealth programs in which more

seasoned and specialized healthcare providers can supply mentoring and/or direct patient care in

real time from remote locations.

Present Technological Limitations. While enhancements to infrastructure and

technology have been operationalized in brick and mortar facilities across all services under

DoD, field environments are still expected to rely on asynchronous solutions in which medical

data is cached locally until a connection can be established back to MHS Genesis, hosted on the

MEDCOI network (Francisco, 2019). This process essentially obviates many advantages

presented by the transition to MHS Genesis. If a means to maintain continuous connection to

MHS Genesis were available, it would enable a more optimal care environment as well as better

uniformity with established best practice workflows; this is achievable via 5G. Because 5G

cellular stations do not usually require the arduous installation associated with installation of a

land-based network (including digging of tunnels and laying of actual fiberoptic cable across

large bodies of water), contracting with local and regional 5G service vendors to design a DoD-

specific MEDCOI 5G network would be considerably less expensive than the transition to a

fiberoptic network. Further, and most germane to the present proposal, 5G would enable real-

time, synchronous telehealth opportunities with providers in brick and mortar facilities.
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IN SUPPORT OF UNITED STATES NAVY COMBAT OPERATIONS
Proposal

Building upon the land-based telehealth capabilities enabled by the implementation of the

MEDCOI network, this paper proposes investment in architecting 5G wireless networking

technology for use aboard Navy vessels and, where possible, in combat environments. Such an

infrastructure will expand the Navy’s ability to treat complex cases in austere environments by

connecting expert advanced practitioners with properly trained allied health staff. In February

2019, surgeons in Barcelona performed the first tele-mentored 5G surgery guided by a remote

surgeon-mentor using Vodafone’s 5G network (Lacy, 2019). The network recorded the

operation from all angles and streamed information outside the operating room in real time. This

effort demonstrated the benefits of 5G, including ultra HD capabilities, high bandwidth and real-

time responsiveness. The remote surgeon-mentor, Antonio Maria de Lacy, described the surgery

as a groundbreaking innovation. "I am drawing with my hand on this screen, and at the same

time on their screen,” he said. “Before 5G, we had to freeze the image to draw, but the surgeon

is moving on and that is not ideal" (Kottasová, 2019).

Conclusion

Cerner’s EMR software existed for many years before DoD was able to build the

MEDCOI network to support implementation; similarly, software to support 5G remote

mentoring already exists, as evidenced by the success of the Barcelona pilot effort. Thus, this

proposal suggests two approvals: (1) that DoD, DHA and/or Department of the Navy (DON)

procure the 5G remote-mentoring software and hardware needed to provide the service at the

point of care; (2) that DoD, DHA and/or DON procure a dedicated 5G MEDCOI cellular

network to support the remote-mentoring implementation. The information presented in the

appendix will support that this is a feasible effort well worthy of taxpayer investment.
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References

Chappellet-Lanier, T. (2018, July 27). Pentagon adds $1B to EHR price tag to ensure

interoperability with VA. Retrieved May 09, 2019, from

https://www.fedscoop.com/defense-extends-ehr-contract/

Fisher, T. (2019, May 08). When Will 5G Be Available in Your Country? Retrieved May 09,

2019, from https://www.lifewire.com/5G-availability-world-4156244

Francisco, P. (2019, May 08). Question and Answer with CDR Stephen Guidry, NC, USN

[Personal interview].

Kottasová, I. (2019, February 27). Doctor uses 5G to direct surgery live from a stage at Mobile

World Congress. Retrieved May 09, 2019, from

https://www.cnn.com/2019/02/27/tech/5G-surgery-mobile-world-congress/index.html

Lacy, A., & Gastrointestinal Surgery Department of Surgery Hospital Clinic - University of

Barcelona. (2019). 5G opens the future of telesurgery. Retrieved May 09, 2019, from

https://healthmanagement.org/c/healthmanagement/issuearticle/5G-opens-the-future-of-

telesurgery

Petty, A. (2018, August 02). DHA Beefing up Infrastructure Ahead of MHS Genesis. Retrieved

May 09, 2019, from https://iq.govwin.com/neo/marketAnalysis/view/DHA-Beefing-up-

Infrastructure-Ahead-of-MHS-Genesis/2931?researchTypeId=1&researchMarket=

Segan, S. (2019, April 16). What Is 5G? PC Magazine. Retrieved May 8, 2019, from

https://www.pcmag.com/article/345387/what-is-5G
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Appendix A

Workflows