Before the FEDERAL COMMUNICATIONS COMMISSION Washington, DC ) ) ) ) ) ) ) INITIAL COMMENTS OF THE WMTS COALITION

TABLE OF CONTENTS EXECUTIVE SUMMARY... ii I. BACKGROUND...3 II. SUMMARY...8 III. THE FINAL BAND PLAN MUST RETAIN THE ALLOCATION OF CHANNEL 37 FOR THE WIRELESS MEDICAL TELEMETRY SERVICE...10 IV. A. The Creation of the WMTS has been a Huge Success; Channel 37 is Heavily Occupied as a Primary Resource for Wireless Medical Telemetry Systems....10 B. The Costs and Burdens to Relocate to a Different Frequency Band would be Overwhelming....12 C. The Out-of-Pocket Dollar Cost to Relocate Channel 37 WMTS Users to Other Spectrum is Only a Part of the Adverse Impact....18 THE FCC SHOULD NOT ALLOW ADDITIONAL UNLICENSED OPERATIONS IN CHANNEL 37...20 V. THE PROPOSALS FOR HIGH POWER DTV STATIONS ON ONE SIDE OF CHANNEL 37 AND NUMEROUS LTE BASE STATIONS ON THE OTHER SIDE MAY GREATLY CONSTRAIN WMTS USE OF CHANNEL 37...24 VI. CONCLUSION...30 i

EXECUTIVE SUMMARY The Coalition applauds the Commission for recognizing, in its lead band plan, that Channel 37 should be retained for the Wireless Medical Telemetry Service (the WMTS ) and Radio Astronomy. As demonstrated below, the hard costs of relocating incumbent WMTS systems are significantly higher than the $300,000,000 provided in the Spectrum Act by an order of magnitude or more. Suggestions in the NPRM that Channel 37 would be a suitable resource for other unlicensed devices ignore the substantial use of this band by WMTS. The potential threat to patient safety created by the widespread use of unlicensed devices operating co-channel to WMTS devices is too great to allow such devices to share this band. Finally, as the FCC considers band plans for uses of adjacent channels 36 and 38, significantly more use of these channels resulting from repacking and reallocation could have materially adverse impacts on the use of Channel 37 by existing and future WMTS licensees. Incumbent DTV operations on Channels 36 and/or 38 already greatly constrain WMTS usage of Channel 37 in certain areas of the country. Therefore, any uses of these adjacent channels should be carefully crafted to assure that Channel 37 WMTS uses are not threatened with increased interference or significantly reduced efficiency and reliability. ii

Before the FEDERAL COMMUNICATIONS COMMISSION Washington, DC 20554 In the Matter of Expanding the Economic and Innovation Opportunities of Spectrum Through Incentive Auctions ) ) ) ) ) ) ) GN Docket No. 12-268 To: The Commission INITIAL COMMENTSOF THE WMTS COALITION The WMTS Coalition, whose members are listed on Exhibit A attached hereto, hereby provide comments on the band plan and technical rules proposed by the Commission in the Notice of Proposed Rulemaking in the above-referenced proceeding. 1 In the NPRM, the Commission has initiated the complex process of developing rules for a new incentive auction by which spectrum can be made available for future wireless telecommunications services in the so-called 600 MHz Band (between 470 MHz and 698 MHz), while also assuring that incumbent uses of the band are not unduly harmed. Because the bands subject to potential reallocation include the 608-614 MHz band ( Channel 37 ) in which the Wireless Medical Telemetry Service (the WMTS ) is one of the primary uses, the WMTS Coalition has a significant interest in this matter. 1 FCC 12-118, 27 FCC Rcd 12357, released October 2, 2012 (the NPRM ). These comments represent the general consensus positions of the Coalition; however, individual members of the Coalition may file their own comments discussing other issues arising out of the NPRM, or even differing with the Coalition s view on a particular issue addressed in these Comments.

This Commission has consistently recognized the importance of wireless telemetry to, and its value in, the nation s healthcare infrastructure. In June, for example, Chairman Genachowski noted that the odds of surviving a cardiac arrest are twice as high for monitored hospital patients, compared to unmonitored patients. 2 Therefore, in developing a band plan that will meet the Commission s public interest objectives for this proceeding which provide the potential for a significant improvement in wireless telecommunications services available to consumers the agency must also remain cognizant of the public interest in avoiding adverse impacts on the provision of health care services using wireless medical telemetry. For the reasons described below, the Coalition urges the Commission in the strongest terms to assure that Channel 37 remains available -- and viable -- as a primary resource for wireless medical telemetry systems. The final band plan should not re-allocate Channel 37 for mobile or broadcast use. Channel 37 should instead remain as it is currently allocated, for WMTS and Radio Astronomy. If any new services are allowed to use Channel 37, they should only be authorized to do so after it can be conclusively demonstrated that such use will not create even the smallest threat of interference to the WMTS licensees who are operating in the band. Moreover, as new or more expanded uses of frequencies immediately adjacent to Channel 37 are contemplated in the final band plan, the Commission must remain cognizant of the potential for harmful adjacent channel interference into WMTS licensed systems. The Commission should assure that adjacent channel interference will not impair the reliability of Channel 37 for incumbent and future WMTS users. 2 Prepared Remarks, FCC Chairman Julius Genachowski, FCC Mhealth Summit, June 6, 2012, at 3, http://www.fcc.gov/document/chairman-genachowski-fcc-mhealth-summit. 2

I. BACKGROUND Wireless biomedical telemetry devices are used in hospitals to transmit waveforms and other physiological data from patient measurement devices to a nearby receiver s antenna providing early detection of life-threatening physiologic developments so that appropriate intervention can be rendered in a timely manner. WMTS devices may monitor ECG, oxygen saturation, blood pressure, respiration, and a variety of other characteristics, providing patients with mobility and comfort while allowing them to be monitored for adverse symptoms. 3 Telemetry patient monitoring is expanding beyond cardiac patients to include monitoring of other acute patients. Wireless medical telemetry today includes measurement and recording of a variety of physiological parameters and other patient-related information via both one-way and bi-directional devices. In order to appreciate the importance of protecting the availability of Channel 37 for WMTS licensees in this proceeding, it is worthwhile to recall how and why this band was allocated for use by the WMTS on a licensed basis almost 13 years ago, co-primary with the Radio Astronomy service. Prior to the creation of the WMTS in 2000, wireless medical telemetry systems generally operated on an unlicensed basis pursuant to Part 15 on vacant VHF and UHF television channels or on a secondary basis under Part 90. Most systems operated in either the 450-470 MHz band allocated for land mobile use or vacant 3 See Amendment of Parts 2 and 95 of the Commission s Rules to Create a Wireless Medical Telemetry Service, Report and Order, ET Docket 99-255, 15 FCC Rcd 11206 (2000) (WMTS Report and Order). 3

TV channels, including the 608-614 MHz band allocated on a primary basis for Radio Astronomy. However, as rules allowing the use of the Land Mobile Radio allocations were changed to provide for higher powered systems, incidents of interference to licensed wireless medical telemetry systems increased; and the Commission temporarily froze acceptance of applications for higher powered land mobile licenses to mitigate against the problem. 4 As the DTV transition was initiated and UHF television stations began testing their DTV transmissions on previously unused channels, a broadcast station in Dallas, Texas caused considerable harmful interference to wireless medical telemetry systems operating at the Baylor Medical Center. 5 These circumstances amply highlighted the need for the Commission to consider a primary allocation of spectrum in which wireless telemetry systems could operate without objectionable interference. Working cooperatively with the FCC and the Food and Drug Administration (the FDA ), the American Hospital Association ( AHA ) created a task force of hospitals, clinics and other users of wireless medical telemetry systems, manufacturers of wireless medical telemetry devices, and trade associations involved in the development of medical devices and the delivery of health care services. The AHA task force was charged with 4 See Freeze on the Filing of High Power Applications for 12.5 khz Offset Channels in the 450-470 MHz Band, Public Notice, 10 FCC Rcd 9995 (WTB 1995). 5 See Joint Statement of the Federal Communications Commission and the Food and Drug Administration Regarding Avoidance of Interference Between Digital Television and Medical Telemetry Devices, released March 25, 1998 and Office Of Engineering And Technology Fact Sheet, Sharing of Analog and Digital Television Spectrum by Medical Telemetry Devices, dated March 1998. 4

determining likely spectrum requirements for wireless medical telemetry in the reasonably foreseeable future and identifying suitable alternatives for satisfying those needs. The result of the AHA task force efforts was a proposal that the Commission create the WMTS; provide a primary allocation for the WMTS in the 608-614 MHz band shared with Radio Astronomy; create another primary allocation for the WMTS in the 1.4 GHz band in which future expansion could be accomplished; and license the WMTS by rule, requiring only registration of WMTS systems with a new database administrator rather than through individual licenses issued by the FCC. The database would be designed to provide newly installed systems with information about incumbent systems operating in close proximity in order to minimize the potential for inter-wmts system interference in their design and implementation. In 1999, the Commission initiated Docket 99-255 to determine the need for, and the parameters of the WMTS; 6 and in June, 2000, the Commission established the WMTS as a new radio service under Part 95 of the Rules. 7 In creating WMTS, the Commission stated that its objectives included allow[ing] potentially life-critical medical telemetry equipment to operate on an interference-protected basis and to improve the reliability of this service. 8 The Commission stated that [a] specific allocation [to WMTS] is 6 Amendment of Parts 2 and 95 of the Commission s Rules to Create a Wireless Medical Telemetry Service, Notice of Proposed Rulemaking, 14 FCC Rcd 16719 (1999). 7 WMTS Report and Order, 15 FCC Rcd 11206, 11210. 8 Id. at para. 1. 5

necessary in this case to protect the public safety by providing spectrum where medical telemetry equipment can operate without interference. 9 In allocating spectrum for the WMTS, the Commission recognized that in making available 14 MHz of spectrum... we note that these bands each have significant constraints [like Radio Astronomy and/or interference from adjacent TV channels], such that the entire allocation is unlikely to be available in any individual market. 10 Nevertheless, the Commission warned that we do not anticipate any further allocations for medical telemetry devices and expect manufacturers and the health care community to ensure that this spectrum is used efficiently to meet long term needs. 11 As demonstrated below, that is exactly what the WMTS community has done. The WMTS has been a rousing success, allowing for the significant expansion of wireless medical telemetry and providing for generally improved patient care and safety. 12 As part of the Middle Class Tax Relief and Job Creation Act of 2012 passed in February, 2012, 13 Congress provided the Commission with authority to implement an Incentive Auction for the UHF spectrum held by broadcasters. The Spectrum Act 9 Id., at para. 11, emphasis added. 10 Id. 11 Id. 12 There have been some reported incidents of interference from adjacent channel DTV stations, see, e.g., http://www.fda.gov/medicaldevices/safety/medsunmedicalproduct SafetyNetwork/ucm127780.htm. However, as discussed in more detail below, manufacturers and system designers have learned how to accommodate the existence of adjacent channel DTV broadcast signals through filtering and other means that generally reduce the bandwidth available for WMTS capacity. 13 Pub. L. No. 112-96, 125 Stat. 156 (the Spectrum Act ). 6

included many details as to how any funds obtained from the sale of spectrum recaptured from broadcasters in the incentive auction should be spent. Funds were to be used in large measure to fund a new Public Safety Radio system, and also to pay for the relocation expenses incurred by broadcast stations that were not sold in the auction but nevertheless needed to be relocated as part of the repacking process. To the surprise of the WMTS industry, however, Congress also provided that a limited amount of funds available from the forward auction of UHF spectrum could be used to reimburse: (iii) a channel 37 incumbent user, in order to relocate to other suitable spectrum, provided that all such users can be-relocated and that the total relocation costs of such users does not exceed $300,000,000. 14 This proceeding was initiated to begin implementation of the proposals outlined in the Spectrum Act. In addition to seeking comment on the variety of issues involved in attempting to recapture UHF spectrum from broadcasters through a voluntary incentive auction, and in conducting a forward auction of the recaptured spectrum to commercial mobile radio services ( CMRS ) licensees, the NPRM provides a broad spectrum of alternatives for allocating any spectrum that is reclaimed through those auction processes. Because Channel 37 sits in the middle of the UHF band in question, the Commission has asked a number of questions as to how it should accommodate incumbent users of Channel 37 -- in that band or possibly in another band. Specifically, the Commission has put forth a band plan (the so-called 600 MHz Plan ) that retains the existing uses for Channel 37. The 600 MHz Plan also proposes to 14 Id., Section 6403(b)(4)(A)(iii). 7

use neighboring Channel 38 to accommodate DTV stations that remain after the incentive auction, on the one hand, and Channel 36 to accommodate CMRS downlinks, on the other. While the Commission has recognized the many public interest benefits for keeping WMTS in Channel 37, it has also asked whether, and to what other frequency bands, incumbent Channel 37 licensees might be moved if an alternative band plan would better suit the other purposes the agency seeks to achieve, and what the costs of such a relocation might be. 15 II. SUMMARY The Coalition applauds the Commission for recognizing, in its lead band plan, that Channel 37 should be retained for WMTS and Radio Astronomy. As demonstrated below, the hard costs of relocating incumbent WMTS systems are significantly higher than the $300,000,000 provided in the Spectrum Act likely by an order of magnitude or more. And those costs don t even consider the impact on health care that the disruption of relocation would create or the significant costs to the WMTS manufacturing community that would have to be incurred in order to implement any such relocation. On the other hand, suggestions in the NPRM 16 that Channel 37 would be a suitable resource for other unlicensed devices ignore the substantial use of this band by WMTS. Any effort to allow other unlicensed devices to share this band, even on some sort of prior coordination basis, would be terribly ill-advised. The potential for widespread, 15 NPRM at para. 212. 16 NPRM at para. 237. 8

uncontrolled use by unlicensed devices operating co-channel to WMTS devices would create a real threat to patient safety. As the FCC considers band plans for uses of adjacent channels 36 and 38, it would be wrong to assume that the lack of a record of a large number of incidents 17 reported to the Commission involving interference to WMTS from the relatively few UHF broadcast station neighbors who operate at higher powers in adjacent channels today justifies adopting similar technical requirements for future users of the adjacent channels. To the contrary, we believe that significantly more use of those neighboring channels resulting from repacking and reallocation could have materially adverse impacts on the use of Channel 37 by existing WMTS licensees. Incumbent DTV operations on Channels 36 and/or 38 already greatly constrain WMTS usage of Channel 37 in certain areas of the country. Given the FCC s cautions when the WMTS was created, 18 WMTS users would appear to have no grounds on which to complain when operating in proximity to an adjacent channel UHF TV station. Instead, the only solution has been to self-mitigate the problem, either by designing a system that uses less than the full 6 MHz of Channel 37 (which can significantly constrain a WMTS deployment), or by deploying in the 1.4 GHz WMTS band or with another modality altogether. But incumbent Channel 37 systems already in place will not have the advantage of this foresight in design if, after repacking and reallocation, additional DTV stations or other higher powered licensees are introduced into these adjacent channels. Therefore, any uses of these adjacent channels should be 17 But see note 12, supra. 18 See, e.g., WMTS Report and Order at para. 19. 9

carefully crafted to assure that incumbent Channel 37 WMTS uses are not threatened with increased interference or significantly reduced efficiency and reliability. Finally, the Coalition notes that merely identifying that one potential outcome of this proceeding is that WMTS systems operating on Channel 37 might be forced to relocate has already had an adverse impact on the health care industry. Hospitals have postponed decisions to upgrade and expand telemetry systems because of uncertainty. Similarly, manufacturers have been loath to invest research and development into improving devices designed for Channel 37 when it might not be available for these uses for the long term. It is impossible to evaluate the long-term impact on patient safety that this uncertainty alone has already had. Indeed, the health care industry stands as an innocent bystander in the spectrum policy debates concerning the expansion of commercial wireless broadband services. The Coalition welcomes the opportunity to comment here, but urges the FCC to move quickly to end the uncertainty, at least with regard to the potential for relocation of WMTS from Channel 37, even if other auction-related issues may require additional comment and reflection by the Commission. III. THE FINAL BAND PLAN MUST RETAIN THE ALLOCATION OF CHANNEL 37 FOR THE WIRELESS MEDICAL TELEMETRY SERVICE A. The Creation of the WMTS has been a Huge Success; Channel 37 is Heavily Occupied as a Primary Resource for Wireless Medical Telemetry Systems. It simply cannot be denied that wireless medical telemetry systems are a key element in the provision of quality health care in the nation s hospitals. WMTS systems are heavily utilized in many sectors of hospitals, large and small, and are critical to 10

improving patient health and safety. As the Commission recognizes in the NPRM, 19 Channel 37 is heavily occupied by incumbent WMTS users. As of January 9, 2013, over 2200 health care facilities had registered Channel 37 WMTS equipment, representing more than 117,000 separate WMTS devices. 20 The Coalition also believes that these numbers do not represent the universe of WMTS devices deployed in Channel 37. To the contrary, based on information provided by manufacturers of WMTS systems as to their sales of systems that operate in Channel 37, the Coalition suspects that the number of WMTS devices currently operating on Channel 37 likely exceeds 200,000. 21 ASHE and the Coalition members continue their efforts to encourage all hospitals employing wireless medical telemetry systems to register with the WMTS database, 22 so it is certain that the number of Channel 37 systems that would be required to relocate will be much larger than the number registered in the WMTS database today. And while a large percentage of newer WMTS system registrations are operating in 19 NPRM at para. 210. 20 Further demonstrating the success of this licensed service, as of the same date, 1395 health care facilities had registered nearly 160,000 separate WMTS devices operating in the 1.4 GHz WMTS allocation. 21 As noted below, as new WMTS systems are installed in hospitals, older WMTS devices with remaining vitality are often re-installed into units within the hospital serving less critical care patients, where monitoring is still vital to rehabilitation and recovery. So the number of devices installed by manufacturers is likely quite close to the number still in operation. 22 The potential impact of the Spectrum Act has already increased registrations of WMTS systems. Whereas ASHE was processing an average of about 550 new registrations annually from 2008 through 2011, more than 1570 new registrations were received in 2012, with the bulk of the new registrations filed since the enactment of the Spectrum Act. 11

the 1.4 GHz band WMTS allocation, 23 Channel 37 remains an important staple for satisfying the needs of many hospitals, both in terms of expansion of existing systems and implementation of new ones. 24 In short, the creation of the WMTS and the allocation of Channel 37 on a primary basis for WMTS licensees has been a resounding success, as a result of which the number of health care facilities potentially affected by relocation would significantly stress the nation s health care industry. B. The Costs and Burdens to Relocate to a Different Frequency Band would be Overwhelming. As the Commission recognized in the NPRM, its ability to require relocation of Channel 37 incumbent licensees is constrained by the Spectrum Act which, the Commission notes, states that the total relocation costs of Channel 37 users cannot exceed 23 Since 2009 and until the recent rush created by the Spectrum Act issues, the number of registrations for the 1.4 GHz band was running 3-5 times as many as those for Channel 37. 24 Keeping its options open, the Commission has asked about limiting eligibility for reimbursement if it chose to reallocate Channel 37 and move WMTS to a new band. Recognizing that the Coalition strongly opposes any such reallocation, the Coalition is equally opposed to the creation of any artificial deadline for determining which WMTS licensees might be eligible for reimbursement. It would be entirely unfair and unduly burdensome for any registered WMTS licensee to be denied reimbursement, without regard to the date of registration. Indeed, if the Commission chose a date that did not give unregistered systems sufficient notice and opportunity to file their registrations, such a requirement would only serve to remove the incentive on existing systems to register further burdening the entire industry. Such a deadline could also severely disrupt the current marketplace for WMTS equipment, as it would essentially punish any hospital that is currently installing, or might plan to install a new WMTS system in the band by discriminating against it as to any reimbursement for relocation that might be made available. Given that the funds available under the Spectrum Act are already woefully deficient, the Commission would not solve any problems by restricting eligibility for any part of the fund based on an artificial deadline for being registered. 12

$300 million. 25 Even without regard to the potential costs of relocating Radio Astronomy Service licensees, the other primary users of Channel 37, the evidence is overwhelming that the Commission could not accomplish the relocation of incumbent WMTS licensees from Channel 37 to any other frequency band in anything close to the amount of money available under the Spectrum Act. Based on a confidential survey of manufacturers of WMTS equipment operating in Channel 37, Coalition member American Society for Healthcare Engineering ( ASHE ) estimates that the average equipment costs associated with changing a WMTS Channel 37 system to a different frequency band would exceed $7,000 per device, and for most systems, likely average as much as $10,000 per device or more. 26 Taking into account the number of current WMTS registrations for Channel 37, the Coalition conservatively estimates that the aggregate total relocation cost for equipment changes alone would be almost $2 Billion, nearly 7 times the amount allocated by Congress for this task. And this 25 NPRM at para. 181, n. 266; see also para. 199, n. 293. 26 For clarity, the Coalition has aggregated the cost of replacing all parts of a WMTS system that could not be reused in a relocation, both the fixed and variable costs, and then averaged that aggregate cost over the number of transmitters associated with a system, resulting in a per transmitter cost. Using that averaging, the cost to replace a Channel 37 WMTS system with a comparable system averages between $5,000 and $17,500 per device, depending on the manufacturer. While some parts of the system (e.g., monitors) might be useable in a replacement system, for the most part (as noted in detail below), the significant percentage of system components, i.e., transmitters, receivers, antenna, would have to be replaced without regard to which new frequencies were allocated to WMTS licensees. 13

amount does not include the administrative, engineering, taxes, installation and other costs that would have to be incurred by a hospital that was required to relocate to a new band. 27 It might seem that a small shift in spectrum allocation (e.g., up or down only a few UHF channels) would allow incumbent WMTS licensees to retain and reuse substantial elements of their existing WMTS systems. Unfortunately, given the nature of the installed base of equipment, the Coalition is certain that any effort by the FCC to relocate the WMTS to a new band, no matter how close in the spectrum that new band might be, would require the wholesale replacement of a material portion of the installed equipment of incumbent WMTS licensees. Ironically, the Commission s own charge in establishing the WMTS is one of the historical reasons for this problem. In creating the WMTS, the Commission noted that Medical telemetry service providers operating on 608-614 MHz (television channel 37) currently must accept adjacent channel interference from broadcast television stations operating on channels 36 and 38. With this allocation, we are not requiring television broadcasters to protect WMTS from adjacent band interference. 28 Taking this charge to heart, manufacturers of Channel 37 WMTS equipment have designed their systems with appropriate filters to mitigate against the potential for adjacent channel interference from UHF TV licensees, thereby making retuning effectively impossible. As such, any relocation will require a significant replacement of the entire system. 27 The Coalition believes that these costs are likely to add 20-30% to the relocation costs, bringing the potential out of pocket expenses that would be incurred by the health care industry for relocation of WMTS licensees out of Channel 37 to more than $2.4 Billion. 28 WMTS Report and Order, 15 FCC Rcd 11206 at para. 19. 14

WMTS installations are typically large complex systems configured to match the specific needs (patient capacity, coverage area) and constraints (DTV signal levels, building construction, etc.) of the environment in which they are installed. It should also be remembered that many medical telemetry systems that were operating throughout portions of the TV spectrum on unused TV channels were later modified to operate on Channel 37 exclusively when the WMTS rules were adopted. To operate in urban areas with active TV stations adjacent to Channel 37, fixed order filters are deployed in the distributed WMTS antenna systems and also within the receivers. 29 Some transmitters are designed with frequency synthesizers; these have a narrow tuning range limited by physical constraints of design, so the transmitters cannot tune outside the TV spectrum. Most of the key subsystems are designed to be narrowband and non-tunable outside 608-614 MHz (e.g. devices, access points and active antennas typically contain integrated 608-614 MHz band pass filters). Going forward, significant investment would be needed to redesign the hardware which includes transmitters, receivers and distributed antenna systems. For most existing systems, wholesale replacement would be required. Relocation would also result in the loss of useful life of a significant portion of the installed base. While most WMTS devices are designed for a 7-10 year life cycle, they typically operate safely and efficiently for a much longer time. As such, even when a hospital purchases new wireless telemetry equipment for its most critical care patients, the 29 As discussed below, however, this filtering also reduces the efficient bandwidth for systems that are, in fact, operating in close proximity to a UHF TV station. In some cases as much as two out of the six megahertz of bandwidth is not available for use. 15

legacy equipment typically can be repurposed for use in other departments of the hospital. For example, as new equipment is installed in the cardiac care unit for critically ill patients, existing equipment might be repurposed into a cardiac rehabilitation unit, where wireless monitoring can provide those patients with significantly greater range of mobility within the unit or hospital itself. In the Coalition members experience, it is not unusual for WMTS devices to remain in service without regard to their age until they cease to function, which could be 20 years or more. Relocation would be wasteful with little benefit in terms of improved health care. Nor can the Commission reasonably assume that relocation could be accommodated in the other WMTS spectrum in the 1.4 GHz band. While many WMTS manufacturers offer systems operating in the WMTS allocation at 1.4 GHz, all do not. In fact, while the use of the 1.4 GHz band for WMTS systems continues to grow, a significant number of manufacturers have focused most, if not all, of their R&D and marketing for WMTS on Channel 37 products. As such, the capacity to manufacture and market 1.4 GHz equipment is limited. Importantly, many hospitals currently employ both Channel 37 and 1.4 GHz equipment, much of which is operating near or at capacity. For these hospitals, the 1.4 GHz band could not accommodate relocation of their WMTS requirements being served on Channel 37, much less the reasonable demand for future growth. Even if the 1.4 GHz band could serve as a very short term solution in terms of available capacity, given the size and scope of any relocation that would be required, it is highly unlikely that there would be a sufficient inventory of 1.4 GHz equipment available in any reasonable period of time to satisfy the relocation of WMTS from Channel 37. Nor 16

is there any reason to believe that there are enough engineers and installers to accomplish that task in any meaningful timeframe for all affected hospitals. 30 The Commission must also remember that unlike Channel 37 -- which is a restricted band in which intentional radiators operating under Part 15 may not operate 31 -- most other bands in the UHF spectrum under consideration in this proceeding are not so restricted. Moving WMTS systems to another UHF band could therefore subject WMTS to interference from a plethora of existing Part 15 devices as well as devices licensed under Part 74 that might be brought into the hospital environment (both consumer and enterprise devices). Indeed, there are virtually no UHF bands to which WMTS could be moved that would not likely create an environment in which WMTS systems would be susceptible to interference from such devices in and around the hospital environment. While this problem might be capable of mitigation in the design of future WMTS products for any new band, such efforts would impact equipment design and R&D expenses, adding further to the already overwhelming equipment costs associated with any relocation. In sum, the equipment costs needed to replace incumbent WMTS systems resulting from a Commission decision to relocate WMTS licensees out of Channel 37 would be staggering. Estimates of the out-of-pocket equipment costs alone, well exceeding $2 Billion, dwarf the $300 Million allocated by the Spectrum Act. The Commission s initial 30 Remembering that the provision of health care, and not the installation of equipment, is a hospital s primary task, very few hospitals employ full-time resources for such installations. Moreover, the burden on manufacturers to obtain and provide the resources necessary to design, engineer and then properly install equipment in a relocated band for the entire incumbent base in an artificially compressed period of time would be crushing. 31 See, e.g., Section 15.205(a) of the FCC s Rules. 17

analysis in the NPRM rings true Channel 37 should remain allocated to the Wireless Medical Telemetry Service. C. The Out-of-Pocket Dollar Cost to Relocate Channel 37 WMTS Users to Other Spectrum is Only a Part of the Adverse Impact. The costs of equipment associated with the relocation of incumbent Channel 37 WMTS systems to a new band tell only a part of the burden that would be faced by hospitals affected by such a decision. Indeed, the intangible expenses that would be incurred by the health care industry in attempting to relocate incumbent WMTS systems to a new frequency are no less daunting then the out-of-pocket costs. Even when the out-of-pocket expenses of a relocation might be reimbursed from auction proceeds, other significant and harmful burdens would be imposed on affected hospitals. In responding to a poll conducted by Coalition member the Association for the Advancement of Medical Instrumentation ( AAMI ), the Methodist Hospital of Houston, Texas, advised: [w]e would have to devote considerable resources to planning and executing any change to the telemetry system. This would have to be done without disrupting patient care so it would be very difficult. We have scarce resources now so redirecting them to a transition in the WMTS telemetry system will keep other priority activities or projects from occurring. Methodist Hospital and others responding to the AAMI inquiry also noted that they are running at nearly full capacity in their use of their wireless telemetry systems. The potential down time of systems while any mandated relocation from Channel 37 was accomplished would create a significant adverse impact on the delivery of patient care. 18

Nor can it be assumed that finding a different band for WMTS even one relatively close in spectrum to Channel 37 -- would solve that problem. The WMTS manufacturing community is a relatively small one. There is simply not enough capacity in this community to redesign and fabricate equipment for any other frequency band -- while retaining capacity to meet existing and short term demands for WMTS devices -- in any reasonable time frame. It must also be remembered that any equipment redesigned to operate in a new frequency band (again, no matter how close to Channel 37 those new frequencies might be) would require FDA clearance before it could be committed to manufacturing and marketing. FDA clearance timeframes must be built into any migration schedule that the Commission might seek to impose. The most aggressive estimates for re-design and FDA clearance suggest at least two years from any decision by the Commission to relocate Channel 37 WMTS incumbents, followed by at least a 2 to 4 year period before manufacturers would be able to produce and begin to install new equipment. The Spectrum Act requires that all reimbursement be completed within three years after the relevant auctions have ended. The Coalition does not believe that there is any reasonable path by which relocation of incumbent Channel 37 licensees could be implemented in the time frames established by the Spectrum Act. Finally, the Commission must also consider the impact on the competitiveness of the WMTS manufacturing community in any determination to relocate the WMTS from Channel 37. Precipitous action could dramatically alter the competitive landscape for these devices. Manufacturers who do not currently have plans for 1.4 GHz equipment and who would need to redesign and retool to move to new spectrum may not be able to survive 19

such upheaval. Even the uncertainty created by the numerous questions and suggestions in the NPRM relating to relocation of Channel 37 for WMTS is already impacting the marketplace. Should the Commission actually order such relocation, it may substantively and adversely impact the manufacturing capacity for these devices. In sum, any effort to mandate the wholesale relocation of incumbent WMTS licensees out of Channel 37 would almost certainly result in the disruption of the industry and a significant setback to future research and development of improved health care capabilities. The Coalition urges, in the strongest terms, that any band plan adopted in this proceeding must start with the determination that the existing allocations for Channel 37 will not be modified. 32 IV. THE FCC SHOULD NOT ALLOW ADDITIONAL UNLICENSED OPERATIONS IN CHANNEL 37 Assuming that WMTS is to remain in Channel 37, the Commission also seeks comment on whether or not Channel 37 might be available to be shared with lower powered unlicensed uses and, if so, under what circumstances. 33 The Commission suggests that this proposal would increase the efficient of use of this spectrum while expanding the amount of spectrum available for innovative unlicensed operations. 34 Given the potential impact on patient safety that could result if interference is created from 32 With this in mind, the Coalition will not comment on alternative band plans that would include a relocation of existing Channel 37 operations. 33 See, e.g., NPRM at para. 237. Specifically, the Commission proposes to make Channel 37 available for unlicensed devices to operate by establishing appropriate protection areas in the white space database. 34 Id. 20

an unlicensed device that may find its way into a hospital and transmit, the FCC should not allow unlicensed devices in this band. And this potential threat will not be adequately mitigated by any technical restrictions imposed on such use (through internal technology or a database restriction). Unless the Commission could provide absolute assurance that the protection zones chosen would be more than large enough to ensure that interference will not occur in any WMTS deployments; whatever mitigation techniques required in unlicensed devices to avoid these protection zones are sufficiently mature to be proven 100% reliable; and a process for frequency coordination to impose those protection zones has been proven to work with a high degree of accuracy, it should not provide any use of Channel 37 by new unlicensed entrants. Because the Coalition does not, today, believe that any of these circumstances can be assured, we strongly oppose any new entry into this band by unlicensed users. There are any number of reasons why the Commission should reject the proposal to allow sharing of Channel 37 between WMTS (and Radio Astronomy) and unlicensed devices. And this is true whether such devices would be operating under a white space database/geolocation regime, or only authorized if they were capable of spectrum sensing (i.e., cognitive radio technology) or any other known approach to interference avoidance. As a practical matter, there are already more than 2200 hospitals with registered WMTS systems operating in Channel 37 whose locations will need to be accurately identified to establish a reasonable protection zone, and that number is growing. While this number is not currently starkly higher than the number of television stations currently being tracked in the White Spaces database, the number of WMTS deployments has been 21

growing while the number of TV stations has been stable or declining. Moreover, the accuracy of the location information concerning broadcast towers is relatively high, typically determined by qualified engineering personnel. Given the importance to air-safety alone, accuracy of the location of a broadcast transmitter tower is at a premium. Similarly, the station s signal contour is relatively static. By comparison, WMTS locations are not registered, in most cases, through measurements by highly qualified engineers, but rather by reference to street addresses of the hospital s location (often then translated by mapping software). As such, WMTS deployment accuracy would not be nearly as high. 35 The registered geographic coordinates are not necessarily the locations of the actual deployments, but may be the coordinates of the mailing address of the hospital or estimates prepared by non-engineers (e.g., from another FCC license, outdoor GPS, Google Earth, etc.). On a large hospital campus, therefore, the actual location of any given WMTS receiver could be a quarter-mile or more away from the protection location identified in the WMTS registration. Moreover, deployment data for a WMTS system is not typically updated or maintained in real time. Expansions of systems into new areas of a hospital or relocation of systems within a hospital campus may not be identified in the database. 36 35 In fact, ASHE has acknowledged that the accuracy of the geographic coordinates for existing WMTS registrations is not within FCC s generally accepted tolerances because the database was not designed for this level of coordination. 36 Given the number of installations in the field which are not already registered, the Coalition believes that the FCC must acknowledge that any database for WMTS installations will not have the level of accuracy that should be required to assure that interference would not occur to a patient wearing a WMTS monitor. 22

Defining a Protection Zone also will be difficult since exclusion zones would need to accommodate large deployment size and geographic coordinate imprecisions. Any effort to define protection distances to take into account some level of inaccuracy would be necessarily require a significant fudge factor, making such protection zones unusually large and, in many urban areas, the useable geographic area in which unlicensed devices could operate, very small. The Coalition is also concerned that many unlicensed devices may be authorized to transmit at higher power levels than the very low-power WMTS devices that are currently installed. As such, the potential for interference on a co-channel basis would extend for a much larger distance from the hospital than any spectrum sensing technology could likely detect. As a result, many hand-held or mobile unlicensed devices could be interfering into a WMTS system without any way of detecting the source. In fact, because most unlicensed devices will be mobile, if interference did occur, the ability to identify the unlicensed user and redress the interference will be extremely difficult if not impossible. That said, even a short-term incidence of interference could have significant impact on patient safety, calling into question the level of reliability that could be expected of WMTS systems operating in a band shared with ubiquitously used unlicensed devices. Indeed, because unlicensed devices can be expected to be extremely ubiquitous over time (potentially numbering in the many millions), and often portable in nature, anything short of 100% effectiveness of the interference protection technology would be intolerable to the level of patient safety that is expected of the WMTS networks. If an unlicensed device operating in Channel 37 is on the market, a patient, visitor or staff person inevitably will bring it into the hospital, regardless of any posted signs or warnings 23

prohibiting use of such devices. Even a very effective (e.g. 99.99%) scheme, applied to millions of devices, would be expected to result in a multitude of cases of interference. Unlike broadcast television, where interference from.01% of White Spaces devices might be annoying, but not intolerable on a temporary basis, the WMTS is a safety-of-life service, so the consequences of that number of incidents of interference would be much more serious. 37 In sum, the risk of interference from co-channel unlicensed devices that operate under control of a geolocation database, cognitive radio technology or other interference-mitigating ideas would be intolerable in a health care facility. The Commission should abandon the proposal to allow unlicensed devices into Channel 37 as part of any band plan adopted in this proceeding. V. THE PROPOSALS FOR HIGH POWER DTV STATIONS ON ONE SIDE OF CHANNEL 37 AND NUMEROUS LTE BASE STATIONS ON THE OTHER SIDE MAY GREATLY CONSTRAIN WMTS USE OF CHANNEL 37 The Commission s 600 MHz Band Plan is clearly the Coalition s favored approach since it leaves Channel 37 untouched by any reallocations of the balance of the UHF spectrum. However, changes made in adjacent channel allocations could indeed, in the Coalition s view, almost certainly will impact the use of Channel 37 for WMTS licensees. It may be too early in this proceeding to favor a particular approach for 37 While a secondary issue, it should be noted that the existing WMTS database was not designed to be shared with other database administrators and there is no existing mechanism to reimburse ASHE for the costs of modifying the WMTS database to accommodate provisioning the database to numerous White Spaces database providers that would need to occur as each new WMTS system is registered with a new protection zone. 24

protecting Channel 37 from adjacent channel interference throughout the nation. However, it is very important that the Commission be aware of the problem, and be sensitive to the concern as it proceeds to a final band plan and to technical rules that will govern the use of Channels 36 and 38 (or at the very least the portions of those channels immediately adjacent to Channel 37). As the Commission notes in the NPRM, [u]nder the proposed band plan, downlink operations would be permitted adjacent to the lower edge of Channel 37. Depending on the amount of spectrum that broadcasters relinquish, uplink operations from mobiles could be permitted on the upper edge of Channel 37. Currently, DTV stations operate adjacent to Channel 37 without any guard bands. 38 Based on this existing circumstance, the Commission then posits that the OOBE [out of band emissions] and power limitations required of DTV stations are sufficient to protect Channel 37 services. 39 Moreover, since both the emissions and power limits that are permitted by DTV operations under current regulations are higher than those proposed for the 600 MHz band... if we adopt the proposed 600 MHz OOBE and power limits, 600 MHz services should provide as much or more protection to Channel 37 than they currently receive from DTV operations. 40 The Coalition respectfully disagrees with the Commission s analysis of current circumstances, and thus with the conclusion that OOBE limits immediately adjacent to Channel 37 will be adequate to protect WMTS from adjacent channel interference. The 38 NPRM at para. 191. 39 Id. 40 Id. 25

Coalition is concerned that actions taken in this docket could create greater incidents of interference from either a significantly more crowded DTV Channel 38 or from the ubiquitous use of Channel 36 by high powered LTE downlink stations. As the Commission properly notes, Channels 36 and 38 are today used principally by UHF broadcasters and licensed operators of wireless microphone systems. But today there are fewer than 80 DTV stations nationwide transmitting on channels adjacent to Channel 37 (Channel 36 or 38); and fewer than 20 DMAs in which the use of Channel 37 is constrained by DTV operations on both sides. As noted above, in creating the WMTS, the Commission decided not to restrict the use of adjacent channels by DTV licensees. To the contrary, the WMTS was expressly subject to adjacent channel interference that might be encountered from a licensed DTV station. 41 With this in mind, the WMTS systems deployed in channel 37 were generally designed to operate with potential exposure for harmonic or spurious emissions from a limited number of active TV stations (for example in a metropolitan area a hospital site might be exposed to some type of signal from not more than 20 TV stations located at varying distances). Most WMTS systems are based on Narrow Band Frequency Modulation (NBFM) technology, using unidirectional communication with no retransmission of data to correct errors. They only offer forward error correction that cannot cope or adapt well to significant interference. For hospitals operating in one of the markets in which Channels 36 or 38 are utilized by an active TV station, extensive filtering is used to mitigate interference. As a 41 WMTS Report and Order, at para. 19. 26

result, for those systems a large part of the WMTS spectrum (approximately 20%) becomes unusable due to TV signal spillover into WMTS spectrum. In these cases, there is a reduction of system capacity (and/or increasing costs to the hospital for maintaining the capacity with additional system components). The fact that those hospitals currently located in close proximity to DTV stations operating on either Channel 36 or 38 have not complained of interference is a matter of good engineering, or the acceptance of a smaller useable bandwidth. The NPRM is simply misguided in suggesting that this circumstance indicates the effectiveness of DTV OOBE limits to protect WMTS systems. Indeed, hospitals using Channel 37 that currently have no active adjacent channel TV station probably will not have employed the additional filtering in their distributed antenna networks. For these hospitals, interference from any newly licensed stations DTV or LTE downlink stations that may be operating in adjacent channels under the proposed OOBE limits would place them at great risk (risk for which they may not be aware until the new stations initiated operations on the adjacent channel). 42 To the extent that a) substantially more TV stations are repacked into Channel 38 and/or b) Channel 36 becomes heavily utilized for CMRS downlinks, the number of WMTS systems impacted by the potential for adjacent channel interference will dramatically increase. Moreover, the Commission s reliance on its experience with DTV station emissions to determine the appropriate OOBE limits for 600 MHz band LTE base stations 42 See, e.g., the several cases discussed at http://www.fda.gov/medicaldevices/safety/ MedSunMedicalProductSafetyNetwork/ucm127780.htm. 27