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WHITE PAPER Enabling Healthcare Connectivity in the United States through Satellite Broadband1 Abstract

Broadband-enabled healthcare solutions2 are essential to providing the necessary level of care and treatment to across the United States, regardless of where they live. However, the ability to provide connectivity hinges on the overall ability of a community to access robust and dependable networks. Many of the areas that rely the most on telehealth for essential medical services, such as for primary care, consultations, and , do not have access to terrestrial broadband services.

Satellite broadband offers high-quality, resilient, already-there coverage of the United States with broadband speeds of 25/3 Mbps or greater, at costs that are comparable to terrestrial providers.

I. Introduction

Telehealth and telemedicine services3 are critical components in the provision of essential healthcare services in America. With a population that is both growing and aging, the demand for medical services is increasing across the United States.4 As demand for medical services increases, there are considerable strains placed on the existing framework for the delivery of medical services that limits the efficacy of how patients are treated and cared for.

Throughout the United States, the supply of trained has been steeped in shortages for years,5 and it is estimated that in the next 10 years, one third of currently practicing physicians will make decisions regarding retirement, further exacerbating this shortage.6 These constraints are being felt in both urban and rural communities alike, making it increasingly difficult for vulnerable populations to obtain medical care.

Rural communities are, additionally, faced with other significant barriers to access, including general workforce shortages, availability of health , distance and availability of transportation, stigma and issues,7 and poor health literacy.8 Even when these barriers are overcome, many rural hospitals lack necessary services that would be available in larger, urban hospitals, such as , dental, substance abuse, and services.9

Telehealth services create opportunities to increase access to and improve the quality of healthcare services throughout the country, especially in rural and remote regions. The increasing prevalence and affordability of solutions make delivery of healthcare services more symbiotic with community needs and can help relieve some of the traditional pressures experienced by healthcare providers.

However, while telehealth services provide relief from many of the traditional constraints on the provision of healthcare services, the ability to provide universal telehealth services throughout the country face its own challenges. Many of the communities that rely, or need to rely, on telehealth services in order to meet the needs of the residents are situated in portions of the country that are unserved or underserved by terrestrial networks. Moreover, lengthy buildout periods and substantial cost outlays for fiber

1 The authors are Jennifer A. Manner, Senior Vice President, Regulatory Affairs, and Jodi Goldberg, Associate Corporate Counsel, Regulatory Affairs at EchoStar Corporation. Hughes Network Systems, LLC, is a wholly owned subsidiary of EchoStar Corporation. 2 For the purposes of this White Paper “Broadband-enable healthcare solutions” will be referred to succinctly as “telehealth services”. 3 “Telemedicine” refers to the remote delivery of healthcare services and information using telecommunication technology, “telehealth” is a broader term for healthcare services, which includes non-clinical services, including training and administration, in addition to the clinical. For the purposes of this White Paper, “telehealth” will be used to encompass both terms. 4 See e.g. Darrel G. Kirch and Kate Petelle, “Addressing the Shortage: The Peril of Ignoring Demography,” American Medical Association, Vol. 317, No. 19, May 16, 2017. Available at: http://jamanetwork.com/journals/jama/article-abstract/2613210. 5 “The recently released 2017 update (internal cites omitted) of annual physician workforce projections indicates that under likely scenarios, the United States will face a shortage of between 40 800 and 104 900 physicians by 2030. Workforce projections for surgical specialties are an area of particular concern, with a projected shortfall of between 19 800 and 29 000 surgical specialists by 2030.” Ibid. 6 Ibid. 7 As there is little anonymity in smaller communities, research has demonstrated a hesitancy on the part of residence to seek out treatment for conditions that carry , such as mental health, substance abuse, domestic abuse, sexual health, or anything else that they do not wish their neighbors to know about. See e.g. Info Hub, Health Care Access in Rural Communities. Available at: https://www.ruralhealthinfo.org/topics/healthcare-access#barriers. 8 Health literacy relates to the ability to understand medical instructions once they have been provided by a primary care practitioner. Ibid. 9 Ibid.

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deployments often make terrestrial broadband service to portions of the country uneconomical given the population density and geography.10 A healthcare facility’s ability to access reliable, high-speed broadband is critical for the provision of telehealth, and even modern, in-person primary care medical consultations.11

Satellite broadband provides ubiquitous coverage of the United States, dramatically increasing unserved and underserved communities’ access to reliable, cost-effective, high speed broadband services. With the ability to meet and exceed current Federal Communications Commission (“FCC”) defined broadband speeds,12 direct-to-consumer satellite broadband offers a cost-effective, easily deployable solution to portions of the country that do not have access to traditional terrestrial networks, as well as a comparable, competitive services in regions that are underserved by terrestrial networks, or where redundancy and resiliency are essential, such as in hospitals and primary care facilities.

Telehealth services are a vital tool in supplying the growing demand for medical services, and create a critical pressure release for a constrained system, especially in the rural portions of the country. In order to ensure the success of these telehealth programs, broadband deployment will have to keep pace with the demand. Satellite broadband plays a quintessential role in ensuring that even the most remote reaches of this country are able to access the medical services they need, through the provision of advanced telehealth connectivity now.

II. The Telehealth Landscape

Telehealth is traditionally viewed as a tool for connecting urban physicians and specialists with rural communities in order to bridge the healthcare gap. Demographics and the availability of healthcare resources in the rural United States has resulted in a population that requires more medical services, and yet has less access to them than their urban counterparts. Rural Americans tend to be older,13 have a lower median household income,14 and live in less densely populated areas.15

While roughly 19 percent of the U.S. population lives in rural communities,16 only 10 percent of physicians choose to practice in those regions.17 When a resident of a rural community requires treatment by a specialist, they are often faced with long wait times for appointments, extensive travel, and time off work.18 Moreover, the lack of resources available to hospitals in these rural communities has resulted in the closure of 74 hospitals since 2010,19 and another 673 are considered to be vulnerable,20 making the options available to patients seeking in-person medical care in rural communities increasingly scarce.21

However, the lack of care providers is not unique to rural populations. The shortage of physicians is increasing nationally, and being experienced similarly in urban centers, making it increasingly difficult for more vulnerable populations to obtain treatment.22 In 2016, there were 6,359 Primary Care Shortage Areas (HPSAs) and 4,362 Mental HPSAs in the United States.23 This resulted in almost 80 percent of adults visiting emergency rooms because they did not have access to another provider, and nearly 50 percent visiting because their doctor was not available.24

Innovative communication underlying the telehealth movement are generating new approaches to deliver high-quality care

10 Carriers incur a cost of roughly $237,600 per mile to lay fiber. 11 See infra Section II. 12 The FCC defines broadband as 25 Mbps download and 3 Mbps upload. See 2015 Broadband Progress Report and Notice of Inquiry on Immediate Action to Accelerate Deployment, GN Docket No. 14-126 (Rel. February 4, 2015). Available at: https://apps.fcc.gov/edocs_public/attachmatch/FCC-15-10A1.pdf. 13 Median age of an urban adult is 45. See U.S. Census Bureau, “New Census Data Show Differences Between Urban and Rural Populations,” December 8, 2016, https://www.census.gov/newsroom/press-releases/2016/cb16-210.html 14 Lower median income is tied to poorer health choices, such as diet, health maintenance, and opting for insurance. Bishaw, Alemayehu and Kirby G. Posey, “A Comparison of Rural and Urban America: Household Income and Poverty,” Census Blogs, U.S. Census Bureau,” December 8, 2016, https://www.census.gov/newsroom/blogs/random- samplings/2016/12/a_comparison_of_rura.html 15 Less densely populated areas have fewer options for treatment and must travel further. See U.S. Census Bureau, “U.S. Cities are Home to 62.7 Percent of the U.S. Population, But Comprise Just 3.5 Percent of Land Area,” March 4, 2015, https://www.census.gov/newsroom/press-releases/2015/cb15-33.html 16 See e.g. Trading Economics, United States – Rural Population. Available at: http://www.tradingeconomics.com/united-states/rural-population-percent-of-total-population-wb- data.html; Kavita Patel et. al, “Transforming Rural Health Care: High-Quality, Sustainable Access to Specialty Care,” December 5, 2014. Available at: http://healthaffairs. org/blog/2014/12/05/transforming-rural-health-care-high-quality-sustainable-access-to-specialty-care/ 17 Ibid. 18 Ibid. 19 See e.g. Mattie Quinn, “With Hospitals in Critical Condition, Can Rural America Survive?” Governing. July 2016. Available at: http://www.governing.com/topics/health- human-services/gov-rural-hospitals-critical-condition.html 20 See e.g. “The Flickering Lights of the U.S. Rural Hospital,” Nebraska Rural Health Association, March 5, 2016. Available at: http://nebraskaruralhealth.org/death-by-a- thousand-cuts-the-flickering-lights-of-the-u-s-rural-hospital/ 21 “Put simply, the economics are stacked against rural hospitals. As one physician observes, ‘You don’t have the volumes. You still have to provide the same quality. You still have to buy the same equipment. You don’t have the economy of scale on the equipment, so your overhead is more and your reimbursements are less.’” (Internal citations omitted). Rick Schadelbauer, “Anticipating Economic Returns of Rural Telehealth,” NTCA, March 2017. Available at: http://www.frs.org/images/ AnticipatingEconomicReturnsOfRuralTelehealth.pdf 22 See e.g. Andrea Kamenca, “Overcoming the Barriers to Telehealth Use in Urban Settings,” University of Arizona, March 31, 2016. Available at: http://telemedicine.arizona. edu/blog/overcoming-barriers-telehealth-use-urban-settings (Discussing how urban patients can lack access to transportation, have poor health literacy, and often experience language barriers). 23 Ibid. 24 Ibid.

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to areas, even with the most minimal resources and limited availability of physicians. Patients are able to connect with physicians in different geographic locations through digital interfaces without having to incur long and expensive travel.25 Physicians are able to access complete medical records for patients who have visited multiple healthcare facilities,26 as well as digital libraries and training platforms to expand the quality of advice they can provide.27 Healthcare facilities are able to seek consultations from specialists in different facilities to save on staffing and resources, such as by sending scans to a centralized radiologist for interpretation.28 Hospitals are even able to reduce the number of occupied beds, by installing monitoring devices in patients’ homes and having care providers do periodic visitations.29 Most importantly, patients are able to see a healthcare provider at the time they need to, in the location that is most convenient for them.

Patient needs are the obvious driving force for adoption of telehealth services, and rural hospitals are outpacing their urban counterparts in the provision of these services, as they rely more heavily on the provision of services through such means.30 However, to expand these offerings, and to enable communities throughout the country to benefit from the advances of telehealth, there is one underpinning assumption that needs to be addressed: telehealth services require a reliable, robust, cost-effective broadband connection over which these services are to be made available. Rural, as well as urban, areas have communication access issues, whether it is the inability to afford the services available, or a lack of broadband infrastructure to the region. Both hospitals and patients alike need to have access to affordable and dependable broadband connections in order for telehealth to provide the relief to the medical system for which it is intended.

According to the FCC’s 2016 Broadband Progress Report, 10 percent of Americans (34 million people) still lack access to broadband services (speeds of 25 Mbps download, 3 Mbps upload).31 That statistic increases to 39 percent (23 million people) when discussing rural communities,32 41 percent (1.6 million) when those people reside on Tribal lands,33 and a staggering 66 percent (2.6 million) when they live in the U.S. territories.34 Many telehealth consumers reside in communities that are unserved or underserved by terrestrial broadband networks, whether because of geography or economics. While many government and private interests are dedicated to the buildout of terrestrial broadband infrastructure, deployment of these networks will take years, if they are ever to come into fruition, and a comparable, competitive service is currently available in these regions that can meet the requirements to support the implementation and expansion of these telehealth service networks.

III. Satellite Broadband for Delivery of Telehealth Services

Satellite broadband services are an essential component to the ubiquitous delivery of broadband services throughout the United States, and particularly for ensuring that critical services, like telehealth, are as easily accessible in rural and remote America as in an urban center. Today’s high-throughput Geostationary Orbit (“GSO”) satellite networks, such as the recently launched EchoStar XIX, provide access to broadband services at speeds of 25/3 Mbps for consumers35 and 50/5 Mbps for enterprise,36 virtually anywhere in the country.37 Future Non-Geostationary Orbit (“NGSO”) satellite constellations, such as OneWeb, are expected to provide even higher speeds with terrestrial fiber-like latency and capacity, including in the most northern areas of the United States.38

Satellite broadband provides three important attributes that are not widely available in terrestrial solutions:

1. Wide area coverage: GSO satellites can provide nationwide coverage with minimal ground infrastructure. Hughes’ three-satellite constellation over the United States, including EchoStar XIX, provide reliable, high-speed broadband services across the Continental United States and southern Alaska.39 The advent of the NGSO systems will enhance current coverage and will enable high-speed

25 Schadelbauer estimates that the cost savings attributable to travel expenses from access to telehealth services would be approximately $5,718 per person. See Schadelbauer, supra note 17, at 13. 26 See e.g. Kevin McCarthy, “The role of EHR in telemedicine,” NueMD, July 28, 2016. Available at: http://www.nuemd.com/news/2016/07/28/role-ehr-telemedicine; see also Stephanie Kanowitz, “Telehealth success depends on integration with electronic health records,” August 25, 2016. Available at: https://gcn.com/Articles/2016/08/25/EHR- telemedicine.aspx. 27 Rural Health Info Hub, supra note 6. 28 JT Ripton and Stefan Winkler, “How telemedicine is transforming treatment in rural communities,” Health , April 8, 2016. Available at: http://www. beckershospitalreview.com/healthcare-information-technology/how-telemedicine-is-transforming-treatment-in-rural-communities.html 29 Schadelbauer estimates that the cost savings for the hospital attributable to access to telehealth services would be approximately $20,841 per patient. See Schadelbauer, supra note 17, at 13. See also, Ripton and Winkler, supra note 24. 30 Julia Adler-Milstein et al, “Telehealth Among US Hospitals: Several Factors, Including State Reimbursement and Licensure Policies, Influence Adoption,” Health Affairs 33, no. 2 (2014), http://content.healthaffairs.org/content/33/2/207.full.pdf+html, p. 210. 31 FCC “2016 Broadband Progress Report,” January 29, 2016. Available at: https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2016-broadband- progress-report 32 Ibid. 33 Ibid. 34 Ibid. 35 Hughes Press Release, “Hughes Announces HughesNet Gen5 High-Speed Satellite Service,” March 7, 2017. Available at: http://sats.client.shareholder.com/ releasedetail.cfm?ReleaseID=1016289 36 Hughes Press Release, “Hughes Launches Industry’s Fastest High-Throughput Satellite (HTS) Service for Enterprise and Government,” March 7, 2017. Available at: http:// sats.client.shareholder.com/releasedetail.cfm?ReleaseID=1016291 37 EchoStar XIX currently provides service throughout the Continental United States and into southern Alaska. 38 See OneWeb Press Release, “Note from Our Chairman,” December 19, 2016. Available at: http://oneweb.world/#solution 39 See Hughes Press Release, “Hughes High-Throughput Satellite Successfully Launched, Setting the Stage for the Next Generation of Satellite Internet,” December 19, 2016. Available at: http://sats.client.shareholder.com/releasedetail.cfm?ReleaseID=1004796; see also OneWeb Press Release, “OneWeb to Seek Access to U.S. Market,” April 28, 2016. Available at: http://oneweb.world/press-releases/2016/oneweb-to-seek-access-to-the-u-s-market www.hughes.com Enabling Healthcare Connectivity in the United States through Satellite Broadband

broadband capabilities to extend to northern Alaska.40 More importantly, GSO and NGSO network coverage is available from the day the satellite network is put into commercial service; all that is required for consumer connectivity is the installation of a small antenna, which can be installed in a matter of days.41

2. Reliability: Since GSO satellites are located 22,300 miles above the earth’s equator, and NGSO satellites are 435 to 6,200 miles above the earth, these networks are not as vulnerable to natural or manmade disasters as their terrestrial counterparts.42 As a result, GSO satellites make up a key component in critical infrastructure monitoring, such as for pipelines. Moreover, in cases of extreme weather conditions, GSO satellites can reallocate power from beams in different regions of the country to those that require more power to ensure that signals continue to get through.43 It is this reliability feature that makes satellites critical for emergency response services and incredibly beneficial for the delivery of telehealth services.

3. Cost-Efficiency: Satellite broadband does not require a costly fiber buildout to each home, business, or cell tower in order to provide service, making it substantially more affordable to construct. While there is a considerable upfront cost,44 there is only a limited terrestrial infrastructure that is needed to support the network in order to provide nationwide service.45 This makes the cost of deploying a satellite broadband network, especially for the purposes of serving rural and remote portions of the country, comparable, if not preferable, to a terrestrial network.

GSO satellite networks play a critical role in ensuring that there is sufficient broadband connectivity to enable telehealth services to meet the escalating healthcare demands of Americans. Satellite broadband offers connectivity now to communities throughout the United States that are unserved and underserved by traditional terrestrial carriers; additionally, they provide a layer of resiliency to fiber-based networks in case of network outages through “path diversity”. Today’s GSO networks provide access to broadband services to hospitals and healthcare facilities, as well as households and small business, allowing people, no matter where they live, to connect with their physicians and care providers.

The broad coverage of a GSO satellite has made satellite services the ideal service provider for dispersed networks, such as department stores and gas stations, for decades and therefore makes them ideal for the provision of new integrated, networks, which are more Cloud dependent [see inset]. Satellite operators, such as Hughes, have experience in designing Virtual Private Networks (“VPNs”) that can protect sensitive patient information while offering nationwide integrated solutions for hospital and other primary care networks.

Managed Cloud Access for Cloud Services for Hospitals. Increasingly healthcare delivery organizations are moving towards Cloud- based services that encompass electronic medical records sharing, patient portal management, billing and compliance. This shift towards digital health means that a new digital divide is emerging on the basis of connectivity across the nation. Satellite solutions like Hughes’ can bridge this divide by providing the necessary , quality of service, and security via its high-capacity and encrypted transmissions. Digital health needs ubiquity to achieve full success and only satellite with its low capital cost, quick install and low maintenance can deliver an economically sustainable solution to the neediest of our communities.

The ubiquity of high-throughput satellite coverage also increases the ability of communities to adopt remote patient monitoring programs. By making cost-efficient broadband services available in entire communities, and therefore, accessible to healthcare centers and patient households, more patients are able to choose to receive care in-home through various remote monitoring options, reducing the cost of care to both the patient and the facility.46 Once connected, residents will have access to the entire cache of broadband services that are available over satellite, including high quality voice services and videoconferencing,47 key components of telehealth connectivity.

Moreover, the “always on” nature of satellite broadband ensures that patients will always be able to connect with their healthcare providers, even in rural and remote portions of the country, and following extreme weather events. As discussed above, satellite networks are not susceptible to the same natural or manmade disasters that can lead to service interruptions in terrestrial networks. Moreover, by creating path diversity, satellite networks can provide additional resiliency to hospitals and healthcare facilities to ensure that even if their terrestrial networks experience an outage, there will always be an open line of communication.

40 See supra note 36. 41 See e.g. https://www.hughesnet.com/frequently-asked-questions. 42 See e.g. Ark-Tex Council of Governments Press Release, “More Resilient with Broadband Satellite,” November 2016. Available at: https://www.hughes.com/sites/hughes. com/files/2017-03/resilient%20911.pdf 43 See e.g. Jim Petranovich, “Mitigating the Effect of Weather on Ka-band High Capacity Satellites,” ViaSat, March 2012. Available at: https://www.viasat.com/sites/default/ files/media/documents/mitigating_the_effect_of_weather_on_ka-band_high_capacity_satellites.pdf 44 A GSO satellite costs roughly $500,000,000 to design, construct, and launch. 45 For instance, EchoStar XIX is supported by only 18 gateways in the United States. 46 See e.g. Adler-Milstein et al, supra note 25. (Discussing the cost penalties built into the Affordable Care Act for readmissions; and a number of studies that have demonstrated a correlation between at-home monitoring of patients with congestive heart failure and a decrease in hospital readmissions by 44 percent, which generated a savings to the program of more than $10 million over six years) 47 See e.g. https://www.hughesnet.com/get-started/hughesnet-voice.

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Senior Care. Senior care is traditionally delivered in various settings—Skilled Facilities (SNFs), Post-Acute Care facilities and residential communities where healthcare is woven into the operational environment. Chronic care patients face a substantial challenge in achieving a certain quality of life and also find themselves with a hefty financial burden. Some of that burden is shared by the facilities that house them. Thus, remote patient monitoring for this segment of our population holds great promise where there is heterogeneity in quality of connectivity to make a remote patient monitoring system scale and work for a community. With the ubiquity of high-speed satellite solutions, these communities can improve the quality of life of their residents, increase early detection screening, lower transportation costs to and between hospitals, and provide off hour urgent care services via remote monitoring. Senior care facilities can also facilitate follow up appointments with specialists via from the comforts of the campus itself. With HD interactive video requiring as little as 500 kbps, high-throughput satellites can provide scalable services to an entire community.

In addition to the robust, reliable, and cost-effective broadband services that are currently delivered by GSO satellites, these systems will be complimented by high-speed, low-latency NGSO constellations by the end of the decade. The addition of the NGSO networks will enhance the telehealth services that can be provided through satellite broadband applications, as the latency will rival, if not surpass, terrestrial fiber. Through NGSO-delivered broadband, it is expected that telehealth applications, even in rural communities, will be able to expand to include real-time diagnostics and robotic .

IV. Ensuring Connectivity: Technology Neutral Access to Scarce Resources

As demand for telehealth services rises across the United States, including in rural and remote areas, so too will the demand for reliable and cost-effective access to broadband. In order for broadband providers to meet these rising demands there will need to be sufficient access to two scarce resources: spectrum and funding. The government, especially the FCC and Congress, must ensure that these resources are provided on a technology neutral basis, so as to foster competition between service platforms.

1. Spectrum: Telehealth services have a wide variety of bandwidth demands, from low data patient monitoring, to high-speed, real- time video consultation; and as with all providers, sufficient access to spectrum is critical to satellite providers’ ability to meet these consumer demands. In order to provide comprehensive healthcare services across the United States, competing platforms will be required to operate in a complementary fashion to meet all broadband service demands throughout the United States. Thus, regulators must ensure that no single technology is benefitted with access to spectrum to the detriment of other services, less service be unavailable to consumers as a result.

This consideration becomes even more paramount as 5G technology advances and complementary technologies, including terrestrial mobile and providers, unlicensed service providers, and satellite providers, will all require access to spectrum resources to ensure the seamless delivery of the . While an equal split of spectrum among the services may not be appropriate, policy makers must take into account several factors, such as the number of users that are supported, the ability of the technology to reach rural and remote parts of the country, resiliency, and the technology’s coverage capability, among others, when making spectrum allocation decisions. This is particularly important in the millimeter wave bands where satellite and terrestrial technologies both have competing demands for access to spectrum.

2. Funding: The provision of telehealth services are dependent on access to broadband networks, which in turn are often dependent on government funding48 to construct these networks to the portions of the country that require service. As telehealth services are offered throughout the country, these services will be supported by a compliment of broadband services, and it is critical that policymakers ensure that funding is allocated to broadband providers based on a weighing of numerous factors, including cost, coverage, reliability, and the likelihood that buildout will occur.

As with the spectrum resource, there is no expectation that funding be equally allocated among the competing platforms. However, it is imperative that the funding regime adopted embrace competition among platforms and not favor one technology over another. Traditional funding programs, such as Universal Service and the Rural Health Care Program, favor terrestrial fiber technologies. While these technologies may have certain benefits, funding programs need to account for the fact that portions of the country, those that are rural, remote, and tribal, will be better served by other technologies that are foreclosed or limited in their abilities to receive funding under these programs.49 Where funding is made available to certain platforms and not others, less connected communities will continue to lag behind in technology adoption, and will often unable to benefit from technology upgrades until long after they have become obsolete in more urban portions of the country.

48 Or, alternatively, a marketplace where no technology service is in receipt of government funding. 49 For example, a 25-point penalty is levied against high-latency services, and an additional 45-point penalty is levied against services that cannot offer gigabit capacity, effectively foreclosing GSO satellite broadband from participating in USF bidding. See Connect America Fund Phase II Report and Order on Reconsideration, (FCC 17-12) WC Docket No. 10-90, WC Docket No. 14-58. (Rel. March 2, 2017).

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V. Conclusion

Telehealth services play a crucial role in alleviating a growing problem with respect to access to healthcare. However, the success of these technological advances will be dramatically curtailed if healthcare providers and patients cannot get sufficient access to broadband services where they live. Satellite broadband offers communities throughout the country the opportunity to access advanced telehealth services today. Through the adoption of technology neutral spectrum policy and funding allocations that encourages competition between service platforms, policymakers will be able to design effective and efficient regulations that promote the deployment of broadband services across the United States. Only through the full complement of broadband services will the United States realize the ubiquitous broadband coverage necessary to have cost-effective, equitable access to healthcare everywhere in the country, regardless of where the patient lives.

Proprietary Statement

All rights reserved. This publication and its contents are proprietary to Hughes Network Systems, LLC. No part of this publication may be reproduced in any form or by any means without the written permission of Hughes Network Systems, LLC, 11717 Exploration Lane, Germantown, Maryland 20876.

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ENABLING HEALTHCARE CONNECTIVITY 11717 Exploration Lane Hughes Network Systems, LLC. HUGHES is a registered trademark of Hughes Network Systems, LLC. Germantown, MD 20876 USA All information is subject to change. All rights reserved. H58610 MAY 17