conclusion 5g

What is 5G?

Fifth time’s the charm: 5G—or fifth-generation wireless technology— is powering the Fourth Industrial Revolution . Sure, 5G is faster than 4G. But 5G is more than just (a lot) faster: the connectivity made possible with 5G is significantly more secure and more stable than its predecessors. Plus, 5G enables data to travel from one place to another with a significantly shorter delay between data submission and arrival—this delay is known as latency.

Here are a few big numbers from the International Telecommunications Union . 5G networks aim to deliver:

1,000 times higher mobile data volume per area
100 times the number of connected devices
100 times higher user data rate
ten times longer battery life for low-power massive-machine communications
five times reduced end-to-end latency

Here’s how it works: like all cellular networks, the service area of 5G networks is divided into geographic sub-areas called cells. Each cell has local antennae, through which all wireless devices in the cell are connected to the internet and telephone network via radio waves. To achieve its very high speeds, 5G utilizes low- and midbands on the radio spectrum (below six gigahertz), as well as whole new bands of the radio spectrum . These are so-called “millimeter waves,” broadcast at frequencies between 30 and 300 gigahertz, which have previously been used only for communication between satellites and radar systems.

Cell phone companies began deploying 5G in 2019. In the United States, 5G coverage is already available in many areas . And, while previous generation 2G and 3G technology is still in use, 5G adoption is accelerating: according to various predictions, 5G networks will have billions of subscribers by 2025.

But 5G can do more than enable faster loading of cat videos. This new speed and responsiveness—and the connectivity solutions it makes possible—is poised to transform a wide variety of industries.

Learn more about our Technology, Media & Telecommunications Practice .

How will 5G be used?

To date, 5G will enable four key use-case archetypes , which will require 5G to deliver on its promise of evolutionary change in network performance. They are:

Enhanced mobile broadband . The faster speed, lower latency, and greater capacity 5G makes possible could enable on-the-go, ultra-high-definition video, virtual reality, and other advanced applications.
Internet of Things (IoT) . Existing cellular networks are not able to keep up with the explosive growth in the number of connected devices, from smart refrigerators to devices monitoring battery levels on manufacturing shop floors. 5G will unlock the potential of IoT by enabling exponentially more connections at very low power.
Mission-critical control . Connected devices are increasingly used in applications that require absolute reliability, such as vehicle safety systems or medical devices. 5G’s lower latency and higher resiliency mean that these time-critical applications will be increasingly reliable.
Fixed wireless access . The speeds made possible by 5G make it a viable alternative to wired broadband in many markets, particularly those without fiber optics.

How might 5G and other advanced technologies impact the world?

If 5G is deployed across just four commercial domains—mobility, healthcare, manufacturing, and retail—it could boost global GDP by up to $2 trillion by 2030. Most of this value will be captured with creative applications of advanced connectivity.

Here are the four commercial domains with some of the largest potential to capture higher revenues or cost efficiencies:

Connectivity will be the foundation for increasingly intelligent mobility systems, including carsharing services, public transit, infrastructure, hardware and software, and more. Connectivity could create new revenue streams through preventive maintenance, improved navigation and carpooling services, and personalized “infotainment” offerings.
Devices and advanced networks with improved connectivity could transform the healthcare industry. Seamless data flow and low-latency networks could mean better robotic surgery. AI-powered decision support tools can make faster and more accurate diagnoses, as well as automate tasks so that caregivers can spend more time with patients. McKinsey analysis estimates that these use cases together could generate up to $420 billion in global GDP impact by 2030 .
Low-latency and private 5G networks can power highly precise operations in manufacturing and other advanced industries . Smart factories powered by AI , analytics, and advanced robotics can run at maximum efficiency, optimizing and adjusting processes in real time. New features like automated guided vehicles and computer-vision-enhanced bin picking and quality control require the kind of speed and latency provided by high-band 5G. By 2030, the GDP impact in manufacturing could reach up to $650 billion .
Retailers can use technology like sensors, trackers, and computer vision to manage inventories, improve warehouse operations, and coordinate along the supply chain. Use cases like connectivity-enhanced in-store experiences and real-time personalized recommendations could boost global GDP up to $700 billion by 2030 .

The use cases identified in these commercial domains alone could boost global GDP by up to $2 trillion by 2030 . The value at stake could ultimately run trillions of dollars higher across the entire global economy.

Beyond industry, 5G connectivity has important implications for society. Enabling more people to plug into global flows of information, communication, and services could add another $1.5 trillion to $2 trillion to GDP . This stands to unlock greater human potential and prosperity, particularly in developing nations .

Learn more about our Technology, Media & Telecommunications Practice.

What are advanced connectivity and frontier connectivity?

Advanced connectivity is propelled by the continued evolution of existing connectivity technologies, as networks are built out and adoption grows. For instance, providers are upgrading existing 4G infrastructure with 5G network overlays, which generally offer improvements in speed and latency while supporting a greater density of connected devices. At the same time, land-based fiber optic networks continue to expand, enabling faster data connections all over the world.

Circular, white maze filled with white semicircles.

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On the other hand, frontier technologies like millimeter-wave 5G and low-earth-orbit satellite constellations offer a more radical leap forward . Millimeter-wave 5G is the ultra-fast mobile option, but comes with significant deployment challenges. Low-earth-orbit (LEO) satellites could deliver a breakthrough in breadth of coverage. LEO satellites work by beaming broadband down from space, bringing coverage to remote parts of the world where physical internet infrastructure doesn’t make sense for a variety of reasons. Despite the promise of LEO technology, challenges do remain, and no commercial services are yet available.

How are telecommunications players grappling with the transition to 5G?

5G promises better connectivity for consumers and organizations. Network providers, on the other hand, are resigned to higher costs to deploy 5G infrastructure before they can reap the benefits. This cycle has happened before: with the advent of 4G, telcos in Europe and Latin America reported decreased revenues.

Given these realities, telecommunications players are working to develop their 5G investment strategies . In order to achieve the speed, latency, and reliability required by most advanced applications, network providers will need to invest in all network domains, including spectrum, radio access network infrastructure, transmission, and core networks. More specifically, operators will increasingly share more parts of the network, including towers, backhaul, and even spectrum and radio access, through so-called MOCN (Multi-Operator Core Network) or MORAN (Multi-Operator Radio Access Network) deals. This is a 5G-specific way for operators to cope with higher investment burdens at flat revenues.

Some good news: 5G technology is largely built on 4G networks, which means that mobile operators can simply evolve their infrastructure investment rather than start from scratch. For instance, operators could begin by upgrading the capacity of their existing 4G network by refarming a portion of their 2G and 3G spectrum, thereby delaying investments in 5G. This would allow operators to minimize investments while the revenue potential of 5G remains uncertain.

How will telecommunications players monetize 5G in the B2C market?

The rise of 5G also presents an opportunity for telecommunications players to shift their customer engagement. As they reckon with the costs of 5G, they also must reimagine how to charge customers for 5G . The B2B 5G revolution is already under way; in the B2C market, the value proposition of 5G is less clear. That’s because there is no 5G use case compelling enough, at the present time, to transform the lives of people not heavily invested in gaming, for instance.

But despite the uncertainty, McKinsey has charted a clear path for telecommunications organizations to monetize 5G in the B2C sector. There are three models telcos might pursue, which could increase average revenue per user by up to 20 percent:

Impulse purchases and “business class” plans . 5G technology will allow telcos to move away from standard monthly subscriptions toward flexible plans that allow for customers to upgrade network performance when and where they feel the urge. Business class plans could feature premium network conditions at all times. According to McKinsey analysis, 7 percent of customers are already ready to use 5G boosters, and would use them an average of seven times per month if each boost cost $1.
Selling 5G-enabled experiences . The speeds and latency of 5G make possible streamlined and seamless experiences such as multiplayer cloud gaming, real-time translation, and augmented reality (AR) sports streaming. McKinsey research shows that customers are willing to pay for these 5G-enabled experiential use cases, and more.
Using partnerships to deliver 5G-enabled experiences . When assessing customer willingness to pay for 5G cloud gaming, McKinsey analysis showed that 74 percent of customers would prefer buying a 5G service straight from the game app rather than from their mobile provider. To create a seamless experience for customers, telcos could embed 5G connectivity directly into their partners’ apps or devices. This could greatly expand telecommunications organizations’ customer base.

How has COVID-19 impacted connectivity IoT?

For one thing, the pandemic has created the need for applications with the advanced connectivity that only 5G can provide. Among other things, 5G enables the types of applications that help leaders understand whether their workforces are safe and which devices have been connected to the network and by whom.

Advanced connectivity technologies like 5G also stand to enable remote healthcare , although, ironically, the pandemic has also eaten up the resources necessary to create the infrastructure to implement it.

During the pandemic, Industry 4.0 frontrunners have done very well. This illustrates the fact that digital first businesses are nimbler and better prepared to react to unforeseen challenges.

Learn more about our Healthcare Systems & Services Practice.

How can advanced electronics companies and industrials benefit from 5G?

The 5G Internet of Things (IoT) B2B market, and its development over the coming years, offer significant opportunities for advanced electronics organizations. 5G IoT refers to industrial use-case archetypes enabled by the faster, more stable, and more secure connectivity available with 5G. McKinsey analyzed the events surrounding the introduction of 4G and other technologies, looking for clues about how 5G might evolve in the industry.

We found that many companies will derive great value from 5G IoT, but it will come in waves . The first 5G IoT use-case archetypes to gain traction will be those related to enhanced mobile broadband, followed shortly thereafter by use cases for ultra-reliable, low-latency communication. Finally, use cases for massive machine-type communication will take several more years. The businesses best placed to benefit from the growth of 5G include mobile operators, network providers, manufacturing companies, and machinery and industrial automation companies.

The B2B sector is especially well placed to benefit from 5G IoT. The most relevant short-term opportunities for 5G IoT involve Industry 4.0 , or the digitization of manufacturing and other production processes. The Industry 4.0 segment will account for sales of about 22 million 5G IoT units by 2030, with most applications related to manufacturing.

In order to take advantage of the opportunity, advanced electronics companies should look now to revamping their strategies . In the short-term, they should focus on B2B cases that are similar to those now being deployed in the B2C sector. Looking ahead, they should shift their focus toward developing hardware and software tailored to specific applications. But expanding the business field is always something that should be done with great care and consideration.

How will 5G impact the manufacturing industry?

There are five potential applications that are particularly relevant for manufacturing organizations:

Cloud control of machines . In the past, automation of machines in factories has relied on controllers that were physically installed on or near machines, which would then send information to computer networks. With 5G, this monitoring can in theory be done in the cloud, although these remain edge cases for now.
Augmented reality . Seamless AR made possible by 5G connectivity will ultimately replace standard operating procedures currently on paper or video. These will help shop-floor workers undertake advanced tasks without waiting for specialists.
Perceptive AI eyes on the factory floor . 5G will allow for live video analytics based on real-time video data streaming to the cloud.
High-speed decisioning. The best-run factories rely on massive data lakes to make decisions. 5G accelerates the decision-cycle time, allowing massive amounts of data to be collected, cleaned, and analyzed in close to real time.
Shop-floor IoTs . The addition of sensors to machines on factory floors means more data than ever before. The speeds made possible by 5G will allow for the operationalization of these new data.

Learn more about our Operations Practice.

For a more in-depth exploration of these topics, see McKinsey’s Technology, Media & Telecommunications Practice. Also check out 5G-related job opportunities if you’re interested in working at McKinsey.

Articles referenced:

“ Unlocking the value of 5G in the B2C marketplace ,” November 5, 2021, Ferry Grijpink , Jesper Larsson, Alexandre Ménard , and Konstantin Pell
“ Connected world: An evolution in connectivity beyond the 5G revolution ,” February 20, 2020, Ferry Grijpink , Eric Kutcher , Alexandre Ménard , Sree Ramaswamy, Davide Schiavotto , James Manyika , Michael Chui , Rob Hamill, and Emir Okan
The 5G era: New Horizons for advanced electronics in industrial companies , February 21, 2020, Ondrej Burkacky , Stephanie Lingemann, Alexander Hoffmann, and Markus Simon
“ Five ways that 5G will revolutionize manufacturing ,” October 18, 2019, Enno de Boer , Sid Khanna , Andy Luse , Rahul Shahani , and Stephen Creasy
“ Cutting through the 5G hype: Survey shows telcos’ nuanced views ,” February 13, 2019, Ferry Grijpink , Tobias Härlin, Harrison Lung, and Alexandre Ménard
“ The road to 5G: The inevitable growth of infrastructure cost ,” February 23, 2018, Ferry Grijpink , Alexandre Ménard , Halldor Sigurdsson , and Nemanja Vucevic
“ Are you ready for 5G? ,” February 22, 2018, Mark Collins, Arnab Das, Alexandre Ménard , and Dev Patel

Want to know more about 5G?

Connected world: An evolution in connectivity beyond the 5G revolution

Unlocking the value of 5G in the B2C marketplace

What is the Internet of Things?

Enabling opportunities: 5G, the internet of things, and communities of color

Subscribe to the center for technology innovation newsletter, nicol turner lee nicol turner lee senior fellow - governance studies , director - center for technology innovation @drturnerlee.

January 9, 2019

Executive summary

Fifth-generation (5G) mobile networks are expected to be the next big leap in mobile broadband. Peak download speeds as high as 20 gigabits-per-second will enable specialized tasks like remote precision medicine, connected cars, virtual and augmented reality, and a wide array of internet of things (IoT) applications.

Nationwide, resilient 5G networks will be needed to accommodate the growing demand for high-speed mobile broadband. While some researchers and analysts suggest that existing 4G Long-Term Evolution (LTE) technology is sufficient for the majority of IoT use cases, this paper argues that only high-speed, high-capacity, low-latency 5G broadband networks will meet the demands of increasing data-intensive applications. Moreover, 5G will support the massive numbers of devices that will simultaneously access the network, which will be far more than 4G LTE can handle. As 5G enables IoT applications, like health care, education, energy and transportation, it is imperative that they operate as anticipated, without fail, every time.

Further, 5G will be a determining factor in whether or not mobile-dependent users fully partake in the global digital economy, especially as smartphones, cell phones, and other wireless-enabled devices become the only gateway to the internet for certain populations. For communities of color that often lack reliable broadband access, 5G represents increased economic opportunity through improved access to social services, such as health care, education, transportation, energy, and employment. While lower-income African-Americans and Hispanics have similar levels of smartphone ownership as whites in the United States, they are more likely to depend on mobile services for online access, which is why 5G networks must be widely available, affordable, and able to support emerging technologies that address public interest concerns.

One area for optimized 5G use will be IoT that can offer tremendous benefits to communities of color whose members are often on the wrong side of the digital divide. This paper explores the relationship between 5G networks and IoT applications, especially as more of these functions become enabled through advanced mobile networks. In this paper, I argue that 5G networks must be nationwide, affordable, and resilient to ensure that these populations benefit from emerging technologies.

By providing both ubiquity and some level of digital equity for marginalized groups, robust 5G networks will ensure these populations are not left behind.

This paper concludes with three policy and programmatic proposals for both government and the private sector to collaborate in the deployment of 5G, while deepening their capacity and reach to communities in the most need of high-speed broadband access. By providing both ubiquity and some level of digital equity for marginalized groups, robust 5G networks will ensure these populations are not left behind.

Introduction

Fifth-generation (5G) mobile networks are expected to be the next big leap in mobile broadband. With expected peak download speeds as high as 20 gigabits-per-second, 5G users will be able to download a full-length movie in seconds and enable specialized tasks and functions, including remote precision medicine, connected cars, virtual and augmented reality experiences, as well as the internet of things (IoT).

More than 500 billion IoT devices, from sensors, to actuators, to medical devices, will be connected to the internet by 2030, according to research from Cisco. 1 The data collected, aggregated, and analyzed by IoT devices will deliver insights across a wide variety of platforms and services, from health care to artificial intelligence innovations. 5G networks will be needed to meet the requirements of these data-intensive IoT devices and related cloud services.

Nationwide, resilient 5G networks will also be needed to accommodate the growing demand for high-speed mobile broadband. While some researchers and analysts suggest that existing 4G Long-Term Evolution (LTE) technology is sufficient for the majority of IoT use cases, this paper argues that only high-speed, high-capacity, low-latency 5G broadband networks will meet the demands of data-intensive applications. High-capacity and high-throughput operations will also be supported through 5G networks, making scaled IoT deployments even more cost effective. As 5G and IoT are broadly applied to life-saving devices and applications in the areas of health care, energy and transportation, it is imperative that they operate as anticipated, without fail, every time.

Further, access to 5G networks will be a determining factor in whether or not mobile-dependent users fully partake in the digital economy, especially as smartphones, cell phones, or other wireless-enabled devices have become their only gateway to the internet.

Further, access to 5G networks will be a determining factor in whether or not mobile-dependent users fully partake in the digital economy, especially as smartphones, cell phones, or other wireless-enabled devices have become their only gateway to the internet. Currently, 95 percent of Americans own a cell phone and 77 percent have smartphones, according to the Pew Research Center. 2 Ownership cuts across demographic groups with African-Americans and Hispanics showing high levels of mobile device ownership. For low-income segments of these populations, wireless connectivity is most likely their only online access.

While IoT and related applications are just one of many use cases powered by next-generation mobile networks, I argue that they offer the most promise for eliminating the disadvantages resulting from the digital divide, especially for certain segments of African-Americans and Hispanics who are severely marginalized or socially isolated. Exploring the relationship between 5G and IoT by drawing upon existing use cases, this paper makes the case for why the United States needs nationwide 5G networks to leverage access to both services and opportunities for these populations.

First, I will explore how access to high-speed broadband can benefit communities of color. Next, the capabilities of 5G networks will be discussed, followed by an overview of the numerous IoT and 5G-enabled applications that, if applied, can greatly benefit online minority users. Finally, the paper will outline three policy and programmatic proposals where the government and private sector can work collaboratively to prioritize nationwide deployment of 5G networks, while broadening their capacity and reach to communities in the most need of high-speed broadband access. Data from a national online poll of 2,000 respondents that I conducted will also be shared in the paper to highlight consumer opinions around 5G deployment and use. 3

Broadband access for communities of color

Twenty-four million Americans lack access to fixed, residential high-speed broadband services, according to 2018 data from the Federal Communications Commission (FCC). 4 This includes 13 percent of African-Americans, 11 percent of Hispanics, 35 percent of those lacking a high school degree, 22 percent of rural residents, and 37.2 percent of households that speak limited English. 5 In this accounting for differences in income, age, education and other factors, many racial and ethnic groups also continue to lag behind whites in residential broadband adoption.

Despite these disparities, mobile access has converged among many of these subgroups. Seventy-seven percent of whites, 75 percent of African-Americans, and 77 percent of Hispanics own a smartphone, according to the Pew Research Center. 6 For many higher-income whites, access to the internet via a smartphone supplements a high-speed, in-home broadband connection, while lower-income populations, less-educated, and younger Americans tend to be more smartphone-dependent, relying on mobile broadband as their primary and oftentimes sole connection to the internet. 7 Further, 35 percent of Hispanics and 24 percent of African-Americans have no other online connection except through their smartphones or other mobile devices, compared to 14 percent of whites. 8 Thirty-one percent of individuals making less than $30,000 per year regularly rely on their mobile device for internet access. 9 Finally, urban residents also tend to be more smartphone-dependent at 22 percent compared to 17 percent of rural and suburban residents.

Many of these smartphone-dependent populations overlap with those impacted by higher rates of unemployment, disparate educational attainment and limited economic mobility. For example, unemployed and under-employed African-Americans may face challenges in meeting current workforce demands due to limited digital skills, training, and access to online job openings. Despite advances in education since the 1970s, African-Americans experience higher rates of unemployment, potentially attributed to the lack of digital access in an information-rich economy (Figure 1).

These disadvantages are compounded by an inability to interact with medical providers, complete homework assignments, and engage government services. As a result, certain African-Americans, like other vulnerable populations, are locked out of opportunities that could enhance their social and economic mobility. Meanwhile, providers who are unable to maintain contact with these populations may find themselves incapable of regularly monitoring chronic diseases, connecting clients to job opportunities in real-time, or assisting students with homework and research assignments in the absence of a physical classroom or library access.

Thus, 5G networks can unleash opportunities across a number of different dimensions for vulnerable populations and, at the most basic level, offer a reliable wireless connection that can reduce the less than desirable impacts of social isolation and disadvantage, which affect certain consumers of color. The next section explores 5G’s capabilities.

5G and the capabilities of next-generation mobile broadband

Each generation of mobile technology has ushered in faster and more reliable cellular and mobile internet connections, enabling a new suite of functional innovations for users. First-generation (1G) cell phones enabled mobile voice communications, while second-generation mobile networks (2G) facilitated more efficient and secure calling services, along with widely adopted mobile messaging services, or short message service (SMS). High-definition video streaming on smartphones and other multimedia applications were made possible by 3G and 4G LTE networks.

These new communications functionalities created new markets and immense value for the U.S. economy. Between 2006 and 2016, the digital economy grew at an average rate of 5.6 percent, accounting for 6.5 percent of the current dollar GDP, according to the Bureau of Economic Analysis. 10 4G LTE contributed to this growth by supporting new digital enterprises, including shared economy apps like Uber, Lyft, and others. Ride-sharing service Uber used 4G LTE to drive its platform, leveraging the GPS location and navigation capabilities of smartphone devices. In its early stage of business, the company gave 4G-enabled handsets to its drivers to ensure the reliability and functionality of navigation systems. 11 Since then, the company’s mobile platforms have supported customer reviews, shared itineraries, among other services.

Social media platforms, including Facebook, have also experienced major growth with the availability of advanced mobile technologies. Facebook’s expansion to mobile in 2007 led to more profitable advertising revenue and increased online subscribership. 12

Compared to 4G LTE, 5G will bring higher bandwidths , lower latency , and increased connectivity to mobile broadband. That is, 5G will allow more data to travel faster over wider coverage areas. 5G bandwidths are projected to be 10 times higher than 4G LTE, which will contribute to the faster transmission of data, images and videos. Lower latency will also enable high-speed virtual and augmented reality video without delays or glitches. Mobile connectivity will be strengthened through “small cell” infrastructure, which will densify 5G wireless signals and improve their movement through concrete buildings, and walls. Small-cell antennas, which can be the size of a pizza box, will also enhance wireless service supporting more devices on the same network at the same time.

IoT use cases and people of color

Not surprising, IoT can be optimized on next-generation mobile networks. By definition, IoT refers to physical things connected to each other using wireless communications services. 13 As a global data infrastructure, IoT devices will generate massive amounts of data, which can be used to streamline and improve a wide variety of services and industries. 5G will be an important input for IoT, especially for devices and applications that require high reliability, strong security, widespread availability, and in some cases, ultra-low latency.

Because 5G’s technical features can simultaneously support massive numbers of devices, certain segments of African-American and Hispanic populations may be able to access services that are insufficiently available in certain urban and rural communities.

When applied to the verticals of health care, education, energy use, and transportation, IoT can reduce the cost of service delivery, make more accurate decisions around outputs (including costs), and empower consumers around individual and community concerns. Many of the advanced technologies will be promising for more isolated and mobile-dependent populations, potentially solving some of their challenges. The remainder of this section describes these IoT use cases more generally.

A. Health care

B. Education

Historically, students of color have faced persistent educational disparities that unfortunately reflect differences in their socioeconomic status. While educational gaps have narrowed between whites and people of color on fourth and eighth grade math tests and fourth grade reading tests (benchmarks for student performance), African-Americans have lagged behind whites and Hispanics in educational attainment. 18 Further, three-fourths of minority students attend schools where a majority of their classmates qualifies as poor or low-income compared to one-third of whites. 19

IoT educational solutions can potentially contribute to more vibrant and robust school learning environments.

These statistics, coupled with the “homework gap,” or the barriers that students face when they don’t have broadband at home, further stifle educational attainment for disadvantaged populations. Data from my national survey shows that use of the internet for homework is lowest among Hispanic (2.4 percent) and African-American (2.5 percent) respondents, which could be attributed to an insufficient or non-existent broadband connection. Universal service programs, such as Lifeline and E-Rate, can help to alleviate some of the barriers to low-income broadband adoption, but they are not wholly sustainable by themselves to level the playing field for students of color. 20

In line with the argument in this paper, IoT educational solutions can potentially contribute to more vibrant and robust school learning environments, including:

Interactive whiteboards;
Tablets and mobile devices;
3-D printers;
Student ID cards; and,
Student tracking systems. 21

IoT can also personalize the learning experience for students by tailoring lessons to the student’s pace and style of learning, and capturing more data about the factors that boost their performance with every lesson. 22 One such application is the result of IBM’s partnership with the textbook publisher Pearson to create software that allows students to ask questions, provides helpful feedback to the student, and keeps instructors updated on student progress. 23 But, these applications and others require high-bandwidth connections, which are often not available or consistent in lower-income neighborhoods.

IoT technologies can also expand the possibilities for what and where students learn. Leveraging IoT, students of color can collaborate with each other and teachers in real time regardless of distance. 24 For example, using virtual reality headsets, students in remote locations can place themselves in a classroom with their peers or transport teachers and students anywhere in the world (or universe) that the curriculum takes them, from inside the human body to the far reaches of the solar system. 25 For students of color in less digitally connected schools, these technologies can make a marked difference in educational outcomes.

In addition to these classroom possibilities, some schools are also engaging IoT applications to:

Embed RFID chips in ID cards to track the presence of students, enabling tracking of tardiness and absenteeism and logging of students’ presence on campus. 26
Deploy GPS-enabled bus systems where routes can be tracked so parents and administrators know where a given bus is at any time. Students can also be notified when the bus is near their pickup location to avoid long waits.
Activate wireless key lock systems in classrooms to ensure student safety.

While these applications can operate over today’s 4G LTE networks, the affordability, scalability, and accessibility of 5G is projected to make these tools even more effective and precise.

C. Transportation

Another noteworthy utility is 5G’s capacity to support machine-to-machine communications. This is crucial for the deployment of safe, reliable, and efficient autonomous vehicles, which need vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communications support. Intelligent vehicles have been shown to reduce traffic congestion, road accidents, and improve consumer mobility–all benefits of particular interest to African-American and Hispanic populations because of various factors: 27

Hispanics and African-Americans experienced a higher rate of pedestrian deaths from 2005 to 2014 (1.40 and 1.74 per 100,000 people, respectively) than whites or Asian-Americans (both .93 deaths per 100,000 people). 28 5G-enabled smart vehicles can significantly reduce such accidents owing to their enhanced sensors.
An observational study conducted by the University of Alabama-Birmingham showed that significant disparities in mobility exist between older African-Americans and whites, which propel disparities in functional ability and physical performance. 29 For elderly people of color—in particular those who live in more rural and remote areas— autonomous vehicles can be a part of the process of aging-in-place by offering some level of independence.
People of color are more likely to be affected by high levels of air pollution due to residential location. Overall, nitrogen dioxide concentrations for nonwhites were 37 percent higher than for whites in 2010. 30 Autonomous vehicles communicating over 5G networks with each other and with smart transportation infrastructure are projected to reduce traffic congestion. 31 The less time that vehicles spend idling in traffic the fewer pollutants are emitted, leading to better health outcomes in communities where minorities live.

For elderly people of color—in particular those who live in more rural and remote areas— autonomous vehicles can be a part of the process of aging-in-place by offering some level of independence.

But, autonomous vehicles need wide area network infrastructure to operate. 32 In the absence of 5G networks with the low-latency to support these transportation solutions, low-income customers in both urban and rural communities are more likely to become victims, rather than beneficiaries of these emerging transportation technologies, simply because their communities are unable to deploy reliable and resilient communications networks.

5G can support wider adoption of clean energy by enabling smart grids that integrate wind, solar, and other renewable sources into existing grids. 33 Because wind and solar power are more decentralized and weather-dependent, electricity grids will need fast and reliable communications over 5G networks to switch power sources dynamically based on availability. Smart grids can expand access to renewable energy sources to all electricity customers without the price increases associated with customers exiting the grid, which disproportionately affects low-income communities of color. 34

The gap in availability of clean energy between low-income communities of color and others will also have devastating consequences if IoT and 5G technologies are not equitably deployed. Generally, African-American and Hispanic households spend 7.2 percent of household income on utility services, or three times more than other households (2.3 percent). 35 Thus, the deployment of 5G-enabled smart grids and smart household meters must anticipate and avoid potential income disparities in access to new energy technology.

5G’s direct impact on employment

African-Americans and Hispanics are also positioned to directly benefit from the workforce opportunities resulting from 5G deployment and use.

African-Americans and Hispanics are also positioned to directly benefit from the workforce opportunities resulting from 5G deployment and use. A recent report from Accenture estimates that the transition to 5G will create 50,000 new construction jobs in the U.S. to install new wireless infrastructure over a seven-year period. 36 During a public event, FCC Commissioner Brendan Carr stated that small-cell deployment would create 27,000 jobs. 37 These numbers do not include additional economic growth from expanding broadband access to Americans. The adoption of 5G technology into the broader economy could also create an additional 2.2 million jobs. 38 Available 5G networks will also be able to connect job seekers to more diverse labor opportunities by enabling more telecommuting through videoconferencing and other remote applications. And, faster connection speeds can help individuals learn new skills through online courses and certifications. This will be critical in ensuring people of color are not further disadvantaged due to a lack of digital or other relevant skills.

In conclusion, high-speed, next-generation broadband networks and IoT, along with the technologies and applications they will enable, could greatly benefit people of color and position them for the emerging pathway to economic and social opportunities.

Policy recommendations

Looking ahead to 5G deployment, this next section outlines three policies, which should be priorities as the government and the private sector seek to realize the full value of advanced mobile services and ensure that certain segments of African-American and Hispanic populations are not left behind.

5G solutions must be able to bolster capacity, speed, and coverage to reach more populations of color.

Efforts to deploy 5G networks must focus on achieving ubiquitous service to minority populations that offers high capacity and speed. Several wireless carriers have already announced plans to launch 5G within certain U.S. cities. 39 Whether the product is being pushed as a substitute for fixed broadband or a complementary mobility solution, emerging 5G networks are expected to offer services beyond traditional mobile services and video, which are two popular use cases for consumers.

While some industry leaders are experimenting with millimeter-wave or higher spectrum frequencies, these bands alone may not be sufficient to penetrate urban structures or go the distance in rural communities, where some of these lower-income consumers live. Because millimeter-wave spectrum transmits at frequencies between 24-79GHz, one of the shortcomings of these higher-frequencies is the reduced ability to travel through buildings, foliage, rain, or other obstacles, as well as go an adequate distance even in unimpeded spaces. Addressing these coverage challenges will be crucial in expanding national broadband access and allowing users to seamlessly take advantage of 5G, IoT, and other next-generation applications.

Given the limitations of millimeter-wave signals, there is a case for the greater use of low-band, or 600–700 MHz spectrum and cellular Specialized Mobile Radio, especially for improved in-building and more rural coverage. Models that embrace a multi-band spectrum approach that leverages both high-, mid-, and low-bands would best serve minority populations and their use of IoT applications and devices by providing greater coverage. This is particularly significant to low-income communities of color, who receive 15 percent less cell phone coverage than their wealthier counterparts, which can largely be due to where they live and their choice of wireless providers. 40 By promoting efforts to ensure that wireless carriers have adequate access to combined mid- and low-band spectrum, policymakers can promote some level of broadband coverage in both urban and rural communities.

Policymakers can also encourage the expeditious deployment of small cells, which will also be critical in serving minority populations who are vastly concentrated in urban areas. Local governments should support the streamlining of siting and permitting processes and standardize pricing on pole attachments. Slow and expensive permitting could not only stifle 5G deployment in these communities, but also lead to slower network upgrades, resulting in lags in the functions of critical IoT applications in health care, public safety, and other areas. In the end, cities run the risk of foreclosing on the opportunities presented by 5G networks through delayed and stalled small-cell rollouts.

Slow and expensive permitting could not only stifle 5G deployment in these communities, but also lead to slower network upgrades, resulting in lags in the functions of critical IoT applications in health care, public safety, and other areas.

From an infrastructure perspective, combined spectrum opportunities that broaden both the capacity and coverage in all communities, along with the blanketing of small-cell antennae, are both reasonable measures that promote both ubiquity and some level of digital equity for marginalized populations and their communities.

5G must be affordable for consumers, despite massive telecom investments and costs.

5G investments are speculated to increase GDP by $500 billion. 41 However, 5G networks will be expensive to deploy, particularly as wireless carriers are projected to invest in multiple network inputs, including spectrum, radio access network (RAN) infrastructure, transmission, and core networks. Telecom companies alone are expected to invest $275 billion over the next seven years in building out 5G networks. 42 Some analysts have suggested that about $200 million will be spent in the 5G deployment in the first few years of service, while other analysts are projecting a $2.4 trillion spend between 2020 and 2030. 43 The largest expenditure for many wireless carriers will be in small cells to drive wireless capacity.

These massive investments may prompt wireless carriers to either subsidize 5G investments, at least in the short-term, or consider passing these costs on to consumers, which could deter widespread adoption.

In the national online survey of 2,000 respondents that I conducted as part of this paper, 47 percent of respondents shared that they would not pay more to double or triple their current speeds. Given this finding, service providers will have to exercise more flexibility in pricing and data caps to ensure affordability and to drive consumer demand for faster networks.

Since 5G will allow for a multiplicity of functions, opportunities should exist for tiered or pre-paid pricing structures that can account for possible cost savings to consumers. For example, some of these savings could come from new market opportunities, including home video or cloud-based services, while other savings could result from 5G’s ability to operate in licensed and unlicensed spectrum, which could offer deeper and more flexible coverage that also results in reduced costs to consumers.

In addition, massive IoT and greater capacity to support scaled deployments of devices is expected to result in lower unit costs. Private sector solutions that leverage multiple spectrum bands, as previously discussed, could also reduce 5G costs by covering more areas and making services available to more low-income users—increasing the volume of subscribers.

There is also a chance that many mobile users will likely reach their monthly cap if data consumption trends escalate as projected. Given these possibilities, it will be important for wireless providers to offer a range of mobile service plans, including unlimited data options, bundles, or pre-paid programs, to ensure affordability for consumers. In the move from 3G to 4G/LTE, subscribers used more data, largely due to the growth of internet-based applications. A 2013 study from Mobidia found that the data usage of 100,000 Android LTE users in the U.S., South Korea and Japan was higher with 4G/LTE. 44 That is, LTE users consumed far more data than those using 3G. According to the study, LTE smartphone users in Korea used on average 2.2GB of data per-month compared to just under 1GB on 3G smartphones—a difference of 132 percent, compared to a 36 percent increase in the U.S. (or, around 1.3 GB LTE data compared to 956MB on 3G).

Overall, the Mobidia study concluded that the greater availability of data would lead to increased usage. 45 The availability of 5G is already anticipated to fuel mobile data traffic growth. By 2021, a 5G connection will generate 4.7 times more traffic than the average 4G connection, according to research conducted by Cisco. 46

Generally, consumers of color have benefited from pre-paid plans over the years, suggesting similar results could occur if these options were extended to 5G customers. For many smartphone owners, the monthly cost of maintaining a device can be a financial hardship, with 23 percent of subscribers having to cancel or shut off their service for a period of time due to cost. 47 In fact, 44 percent of smartphone owners who make under $30,000 per year have done so, and African-Americans and Hispanics are twice as likely as whites to have done the same. 48 When it comes to mobile service, lower-income smartphone users tend to subscribe to relatively low-cost plans (including pre-paid) and often find themselves cancelling their service due as a result of affordability concerns. 49

While the monthly cost of 5G mobile service is not yet determined for consumers, more pre- and post-paid plans, and not less, should be encouraged in the marketplace to guarantee ubiquity in use. Further, more flexibility in data plans and not just rigid caps may be a more viable solution for consumers where cost matters.

While government programs, such as Lifeline, can also alleviate the economic burden for consumers, the discounts must be applied to mobile services, especially as they become the primary conduit to the internet. 50 Once fully deployed, 5G services should be eligible for government subsidies targeted to mobile access to ensure the participation of historically disadvantaged and vulnerable populations in the digital economy.

5G networks must serve the public interest.

Much of this paper is focused on advancing some of the public-good applications of 5G and IoT technologies, such as health care and education. In the race to launch 5G networks ahead of international competitors, including China and Korea, government and industry leaders must keep promoting innovation and growth by emphasizing that next-generation mobile networks will help improve, if not save, the lives of millions of Americans by cultivating better access to social and institutional services.

In the race to launch 5G networks ahead of international competitors, including China and Korea, government and industry leaders must keep promoting innovation and growth by emphasizing that next-generation mobile networks will help improve, if not save, the lives of millions of Americans.

The recent White House memorandum on spectrum policy appears to be in sync with the national efforts to deploy 5G networks. 51 Requesting the coordination of federal agencies on spectrum availability and sharing opportunities, the administration is at least suggesting the removal of federal and regulatory red tape to expedite build-out. The memorandum further designates a spectrum task force drawn from federal agency stakeholders to increase the sharing of scarce spectrum resources among federal agencies and the private sector so that more spectrum is available for commercial 5G wireless networks. The White House’s strategy will also enhance spectrum management through flexible-use licenses that allow for temporary use of spectrum bands.

The FCC has also been working to address outdated regulatory processes and barriers within local bureaucracies that stifle the deployment of local cell sites and other communications infrastructure. Similar to the White House, the agency is working to develop the optimal national criteria for advancing next-generation, mobile networks. 52

These governmental efforts are critical in freeing up the resources required to operate reliable, resilient and nationwide 5G networks. With this type of support, companies can focus on 5G solutions and applications that advance the public good, whether through making dents in health and wellness disparities or helping students gain access to more equitable learning environments and communities. In either case, the increased availability of spectrum will create the allowances for more strategic and purposeful IoT applications that can support communities of color and other vulnerable populations.

5G represents increased economic opportunity through improved access to social services, such as health care, education, transportation, energy, employment, and even public safety for communities of color—and, frankly, any other vulnerable group—that lacks access to a reliable broadband connection. This attribute is particularly important for African-Americans and Hispanics who have become increasingly reliant on mobile networks for broadband connectivity, while experiencing a degree of isolation from institutional and social services.

5G represents increased economic opportunity through improved access to social services for communities of color—and, frankly, any other vulnerable group—that lacks access to a reliable broadband connection.

5G access will not only provide an online gateway, but it will also expose certain populations to myriad benefits, including those enabled by IoT, which can ultimately improve the quality of their lives.

As efforts to advance the new technology become more prominent among legislators, communications providers, and even some citizen groups, U.S. policymakers must work diligently to identify and support 5G network deployment and adoption nationwide, especially in ways that bring exponential benefit to Americans in need. Without these actions, certain populations will remain relegated to the wrong side of the digital divide, failing to realize the power and potential of existing and emerging technologies.

The author would like to thank Jack Karsten and Madhu Kumar for the research support that they provided for this report.

The Brookings Institution is a nonprofit organization devoted to independent research and policy solutions. Its mission is to conduct high-quality, independent research and, based on that research, to provide innovative, practical recommendations for policymakers and the public. The conclusions and recommendations of any Brookings publication are solely those of its author(s), and do not reflect the views of the Institution, its management, or its other scholars.

Support for this publication was generously provided by T-Mobile. Brookings recognizes that the value it provides is in its absolute commitment to quality, independence, and impact. Activities supported by its donors reflect this commitment.

Cisco. 2016. “Internet of Things.” https://www.cisco.com/c/dam/en/us/products/collateral/se/internet-of things/at-a-glance-c45-731471.pdf .
“Mobile Fact Sheet.” 2018. Washington, DC: Pew Research Center , February 5, 2018. www.pewinternet.org/fact sheet/mobile .
This online survey polled 2,000 adult internet users in the United States September 9 to 11, 2018 through the Google Surveys platform. Responses were weighted using gender, age, and region to match the demographics of the national internet population as estimated by the U.S. Census Bureau’s Current Population Survey. This research was made possible by Google Surveys , which donated use of its online survey platform. The questions and findings are solely those of the researchers and not influenced by any donation. For more detailed information on the methodology, see the Google Surveys Whitepaper .
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Barefoot, Kevin, Dave Curtis, William Jolliff, Jessica R. Nicholson, and Robert Omohundro. 2018. “Defining and Measuring the Digital Economy.” Washington, DC: Bureau of Economic Analysis , March 15, 2018. https://www.bea.gov/system/files/papers/WP2018-4.pdf .
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“E-Rate: Universal Service Program for Schools and Libraries.” 2011. Federal Communications Commission. May 24, 2011. https://www.fcc.gov/consumers/guides/universal-service-program-schools-and-libraries-e-rate . “Lifeline Support for Affordable Communications.” 2016. Federal Communications Commission. March 4, 2016. https://www.fcc.gov/consumers/guides/lifeline-support-affordable-communications .
“IoT in the Classroom: How Traditional Education is Changing.” Aldridge. August 17, 2016. https://aldridge.com/future-iot-in-the-classroom-education/
Leligou, Helen C., Emmnouil Zacharioudakis, Louisa Bouta, and Evangelos Niokos. 2017. “5G technologies boosting efficient mobile learning.” MATEC Web of Conferences, vol. 125, p. 03004. EDP Sciences, 2017.
“IBM and Pearson to Drive Cognitive Learning Experiences for College Students.” 2016. IBM News Room. October 25, 2016. https://www-03.ibm.com/press/us/en/pressrelease/50842.wss .
Mirzamany, Esmat, Adrian Neal, Mischa Dohler, and Maria Lema Rosas. “5G and Education.” Bristol, United Kingdom: Jisc, n.d. https://community.jisc.ac.uk/sites/default/files/Education-VM_Extended.pdf .
Kravets, David. 2012. “Tracking School Children with RFID Tags? It’s all about the Benjamins.” Wired, September 7, 2012. https://www.wired.com/2012/09/rfid-chip-student-monitoring/ .
West, Darrell M. “Achieving Sustainability in a 5G World.” 2016. Washington DC: Brookings Institution. November 30, 2016. https://www.brookings.edu/research/achieving-sustainability-in-a-5g-world/ . See also, Harrold, Phil, and Charles Johnson-Ferguson. “The Future of Consumer Mobility: Could Integrated Transport Drive a New Digital Divide? – Industry Perspectives.” https://pwc.blogs.com/industry_perspectives/2015/02/the-future-of-consumer-mobility-could-integrated-transport-drive-a-new-digital-divide.html .
“Traffic Safety Facts: Race and Ethnicity.” Washington DC: NHTSA’s National Center for Statistics and Analysis, August 2009. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/810995 .
Allman, Richard M, Patricia Sawyer Baker, Richard M Maisiak, Richard V Sims, and Jeffrey M Roseman. “Racial Similarities and Differences in Predictors of Mobility Change over Eighteen Months.” Journal of General Internal Medicine 19, no. 11 (November 2004): 1118–26. https://doi.org/10.1111/j.1525-1497.2004.30239.x.
Clark, Lara P., Dylan B. Millet, and Julian D. Marshall. 2017. “Changes in Transportation-Related Air Pollution Exposures by Race-Ethnicity and Socioeconomic Status: Outdoor Nitrogen Dioxide in the United States in 2000 and 2010.” Environmental Health Perspectives 125, no. 9 (September 14, 2017): 097012. https://doi.org/10.1289/EHP959 .
West, Darrell M. “Achieving Sustainability in a 5G World.” 2016. Washington DC: Brookings Institution. November 30, 2016. https://www.brookings.edu/research/achieving-sustainability-in-a-5g-world/ .
Neef, Dale. “Will Self-Driving Vehicles Finally Bring Broadband to Rural America?” Governing the States and Localities , May 31, 2018. http://www.governing.com/gov-institute/voices/col-self-driving-autonomous-vehicles rural-broadband.html .
“5G and Energy.” 2015. Ghent, Belgium: 5G Infrastructure Association , September 30, 2015. https://5g-ppp.eu/wp-content/uploads/2014/02/5G-PPP-White_Paper-on-Energy-Vertical-Sector.pdf .
Because low-income populations are more likely to rent rather than own housing, they are unable to take advantage of the falling cost of rooftop solar units. Unsurprisingly, minority groups around the country have opposed tax incentives for installing solar panels because it excludes renters and raises their utility bills.
“Report: ‘Energy Burden’ on Low-Income, African American, & Latino Households up to Three Times as High as Other Homes, More Energy Efficiency Needed.” 2016. American Council for an Energy-Efficient Economy , April 20, 2016. https://aceee.org/press/2016/04/report-energy-burden-low-income .
Al Amine, Majed, Kenneth Mathias, and Thomas Dyer. “Smart Cities: How 5G Can Help Municipalities Become Vibrant Smart Cities.” Accenture Strategy, 2017. https://www.accenture.com/t20170222T202102__w__/us-en/_acnmedia/PDF-43/Accenture-5G-Municipalities-Become-Smart-Cities.pdf .
Carr, Brendan. “Grassroots Leadership on 5G.” Remarks, Indianapolis, IN, September 4, 2018. https://docs.fcc.gov/public/attachments/DOC-353925A1.pdf.
Al Amine, Majed, Kenneth Mathias, and Thomas Dyer. 2017. “Smart Cities: How 5G Can Help Municipalities Become Vibrant Smart Cities.” Accenture Strategy. 2017. https://www.accenture.com/t20170222T202102__w__/us-en/_acnmedia/PDF-43/Accenture-5G-Municipalities-Become-Smart-Cities.pdf .
Verizon has already introduced their Ultra-Wide band 5G product, which is being tested in 11 national markets, including Ann Arbor, MI, Sacramento, CA, and Washington, DC. AT&T is seeking to launch a standards-based, 5G network in 12 markets, and perhaps more, before the end of 2018. Sprint and T-Mobile, who announced merger plans earlier this year, are proposing a multi-band 5G strategy. The New T-Mobile is expected to support wider 5G coverage in urban areas compared to AT&T and Verizon using T-Mobile and Sprint’s combined millimeter wave holdings of 28GHZ and 39GHZ spectrum bands, the assets of the New T Mobile – which also include 600MHZ and 2.5GHZ spectrum assets.
Nelson, Patrick. 2016. “Low-income neighborhoods have worse cell phone service, study finds.” Network World , May 13, 2016. https://www.networkworld.com/article/3069464/mobile-wireless/low-income-neighborhoods-have-worse-cell-phone-service-study-finds.html .
Al Amine, Majed, Kenneth Mathias, and Thomas Dyer. 2017. “Smart Cities: How 5G Can Help Municipalities Become Vibrant Smart Cities.” Accenture Strategy. https://www.accenture.com/t20170222T202102__w__/us-en/_acnmedia/PDF-43/Accenture-5G-Municipalities-Become-Smart-Cities.pdf .
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Smith, Aaron. 2015. U.S. “Smartphone Use in 2015.” Washington, DC: Pew Research Center , April 1, 2015. http://www.pewinternet.org/2015/04/01/chapter-one-a-portrait-of-smartphone-ownership/ .
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Trump, Donald J. “Presidential Memorandum on Developing a Sustainable Spectrum Strategy for America’s Future.” The White House. https://www.whitehouse.gov/presidential-actions/presidential-memorandum-developing-sustainable-spectrum-strategy-americas-future/ .
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United states department of commerce, 5g listening sessions summary of conclusions.

In fulfillment of the National Strategy to Secure 5G Implementation Plan , NTIA is publishing the 5G Listening Sessions Summary of Conclusions Report. The comments come from two industry listening sessions where stakeholders were asked to identify incentives and policy options to ensure that the United States has adequate sources of secure, effective, and reliable fifth and future generation wireless communications systems and infrastructure. The first listening session was on held on January 28, 2021, on the subject of “ Market Incentives for 5G Security .” The second was held on February 25, 2021, on the subject of “ Vendor Diversity for 5G Security .”

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5G Network: How does it work, and is it dangerous?

The fifth generation of cellular technology, 5G, is the next leap in speed for wireless devices. This speed includes both the rate mobile users can download data to their devices and the latency, or lag, they experience between sending and receiving information.

5G aims to deliver data rates that are 10 to 100 times faster than current 4G networks. Users should expect to see download speeds on the order of gigabits per second (Gb/s), rather than the tens of megabits per second (Mb/s) speeds of 4G .

"That's significant because it will enable new applications that are just not possible today," said Harish Krishnaswamy, an associate professor of electrical engineering at Columbia University in New York. "Just for an example, at gigabits per second data rates, you could potentially download a movie to your phone or tablet in a matter of seconds. Those type of data rates could enable virtual reality applications or autonomous driving cars."

Apart from requiring high data rates, emerging technologies that interact with the user's environment like augmented reality or self-driving cars will also require extremely low latency. For that reason, the goal of 5G is to achieve latencies below the 1-millisecond mark. Mobile devices will be able to send and receive information in less than one-thousandth of a second, appearing instantaneous to the user. To accomplish these speeds, the rollout of 5G requires new technology and infrastructure.

The new network

Since the earliest generation of mobile phones, wireless networks have operated on the same radio-frequency bands of the electromagnetic spectrum . But as more users crowd the network and demand more data than ever before, these radio-wave highways become increasingly congested with cellular traffic. To compensate, cellular providers want to expand into the higher frequencies of millimeter waves.

Millimeter waves use frequencies from 30 to 300 gigahertz, which are 10 to 100 times higher than the radio waves used today for 4G and WiFi networks. They're called millimeter because their wavelengths vary between 1 and 10 millimeters, where as radio waves are on the order of centimeters.

The higher frequency of millimeter waves may create new lanes on the communication highway, but there's one problem: Millimeter waves are easily absorbed by foliage and buildings and will require many closely spaced base stations, called small cells. Fortunately, these stations are much smaller and require less power than traditional cell towers. They can be placed atop buildings and light poles.

The miniaturization of base stations also enables another technological breakthrough for 5G: Massive MIMO. MIMO stands for multiple-input multiple-output, and refers to a configuration that takes advantage of the smaller antennas needed for millimeter waves by dramatically increasing the number of antenna ports in each base station.

"With a massive amount of antennas — tens to hundreds of antennas at each base station — you can serve many different users at the same, increasing the data rate," Krishnaswamy said. At the Columbia high-Speed and Millimeter-wave IC (COSMIC) lab, Krishnaswamy and his team designed chips that enable both millimeter wave and MIMO technologies. "Millimeter-wave and massive MIMO are the two biggest technologies 5G will use to deliver the higher data rates and lower latency we expect to see."

Is 5G dangerous?

Although 5G may improve our day to day lives, some consumers have voiced concern about potential health hazards . Many of these concerns are over 5G's use of the higher energy millimeter-wave radiation, which experts say is no cause for worry.

"There's often confusion between ionizing and non-ionizing radiation because the term radiation is used for both," said Kenneth Foster, a professor of bioengineering at Pennsylvania State University. "All light is radiation because it is simply energy moving through space. It's ionizing radiation that is dangerous because it can break chemical bonds."

Ionizing radiation is the reason we wear sunscreen outside because short-wavelength ultraviolet light from the sky has enough energy to knock electrons from their atoms, damaging skin cells and DNA. Millimeter waves, on the other hand, are non-ionizing because they have longer wavelengths and not enough energy to damage cells directly.

"The only established hazard of non-ionizing radiation is too much heating," Foster said, who has studied the health effects of radio waves for nearly 50 years. "At high exposure levels, radio frequency (RF) energy can indeed be hazardous, producing burns or other thermal damage, but these exposures are typically incurred only in occupational settings near high-powered radio frequency transmitters, or sometimes in medical procedures gone awry."

Many of the public's outcries over the adoption of 5G echo concerns over previous generations of cellular technology. Skeptics believe exposure to non-ionizing radiation may still be responsible for a range of illnesses, from brain tumors to chronic headaches . Over the years, there have been thousands of studies investigating these concerns.

In 2018, the National Toxicology Program released a decade-long study that found some evidence of an increase in brain and adrenal gland tumors in male rats exposed to the RF radiation emitted by 2G and 3G cellphones, but not in mice or female rats. The animals were exposed to levels of radiation four times higher than the maximum level permitted for human exposure.

According to Foster, many opponents to the use of RF waves cherry-pick studies that support their argument, and often ignore the quality of the experimental methods or inconsistency of the results. Although he disagrees with many of the conclusions skeptics have about previous generations of cellular networks, Foster agrees that we need more studies on the potential health effects of 5G networks.

"Everyone I know, including me, is recommending more research on 5G because there's not a lot of toxicology studies with this technology," Foster said.

According to the Wall Street Journal , the Federal Communications Commission (FCC) allowed the rollout of 5G wireless networks in 2019 without changing any prior federal safety limits for RF exposure. That agency, following guidance from the World Health Organization and the US Food and Drug Administration, saw nothing unique in 5G technology that could necessitate additional caution on top of existing guidelines that the FCC says already incorporate a significant safety margin.

For the proponents of 5G, many believe the benefits 5G can provide to society far outweigh the unknowns.

"I think 5G will have a transformational impact on our lives and enable fundamentally new things," Krishnaswamy said. "What those types of applications will be and what that impact is, we can't say for sure right now. It could be something that takes us by surprise and really changes something for society. If history has taught us anything, then 5G will be another example of what wireless can do for us."

Additional resources:

Learn more about previous generations of cellphones and why 5G is the next step .
What do other health experts have to say about cellphone usage?
Find out if 5G is available in your area .

This article was updated on Feb. 1, 2021 by LiveScience Reference Editor Vicky Stein.

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12 Conclusion and Future Outlook

Jonathan Rodriguez

Instituto de Telecomunicações, Aveiro, Portugal

The foreseen increase in the number of connected mobile devices, coupled with the ever more stringent quality of service (QoS) requirements from emerging broadband services, means that employing today’s technologies and strategies for network expansion will fail to deliver competitive tariffs as the transmission cost per bit will rocket. Unless new disruptive techniques are exploited, just opting to ‘buy more spectrum or infrastructure’ to accommodate extra users will no longer solve the issue of operators meeting customer demand effectively in an era when spectral resources are at a premium. As the 4G chapter closes, a new era beckons which requires networking technology to evolve and to be ready for next-generation services and demand. As a new chapter unfolds, we not only need to evolve the legacy system to be more competitive, but we also require new disruptive ideas to secure the 5G market and foster growth for the future. Indeed, we need to adopt a proactive stance in order to be ready for the 5G story. In this concluding chapter, we will harness some of the technology paradigms discussed in the previous chapters to build a picture of the current state of 5G, emphasising some of the challenges that still lie ahead, particularly on green networking and inter-layer design. As a final discussion on the 5G story, the editor shares his vision of the future for 5G mobile. In order ...

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v.25(4); Oct-Dec 2021

5G Use in Healthcare: The Future is Present

Konstantinos e. georgiou.

1 st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Evangelos Georgiou

Medical Physics Laboratory Simulation Center (MPLSC), Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Richard M. Satava

Professor Emeritus of Surgery, University of Washington, Seattle, WA.

Background:

Most healthcare providers are unaware of the extraordinary opportunities for implementation in healthcare which can be enabled by 5G wireless networks. 5G created enormous opportunities for a myriad of new technologies, resulting in an integrated through 5G ‘ecosystem’. Although the new opportunities in healthcare are immense, medicine is slow to change, as manifest by the paucity of new, innovative applications based upon this ecosystem. Thus, emerges the need to “avoid technology surprise” - both laparoscopic and robotic assisted minimally invasive surgery were delayed for years because the surgical community was either unaware or unaccepting of a new technology.

PubMed (Medline) and Scopus (Elsevier) databases were searched and all published studies regarding clinical applications of 5G were retrieved. From a total of 40 articles, 13 were finally included in our review.

Discussion:

The important transformational properties of 5G communications and other innovative technologies are described and compared to healthcare needs, looking for opportunities, limitations, and challenges to implementation of 5G and the ecosystem it has spawned. Furthermore, the needs in the clinical applications, education and research in medicine and surgery, in addition to the administrative infrastructure are addressed. Additionally, we explore the nontechnical challenges, that either support or oppose this new healthcare renovation. Based upon proven advantages of these innovative technologies, current scientific evidence is analyzed for future trends for the transformation of healthcare. By providing awareness of these opportunities and their advantages for patients, it will be possible to decrease the prolonged timeframe for acceptance and implementation for patients.

INTRODUCTION

Today, the explosion of several information and communications technologies radically changes and creates an extraordinary ecosystem for new opportunities in an unprecedented rate. Every sector and industry, including healthcare, has been impacted by digital transformation. Digital innovations including the further expansion of telehealth, the development of fifth generation wireless networks (5G), artificial intelligence (AI) approaches such as machine learning and deep learning, Big Data (BD) and supercomputing, and the Internet of Things (IoT), as well as digital security capabilities such as blockchain, have created an extraordinary opportunity to create an integrated ecosystem for new opportunities in healthcare and other industries. 1 These developments could potentially address some of the most urgent challenges facing health service providers and policy makers, including universal, equitable, sustainable healthcare service.

Together, these integrated technologies can fundamentally change screening, diagnosis and monitoring of diseases, enable more accurate profiling of disease progression and further refine and/or personalize treatments. Nascent technologies for therapy, such as next generation communications, AI, IoT, telesurgery, to name a few, will be addressed.

The fifth generation wireless networks (5G) have an extremely low latency (less than one millisecond (ms) of delay compared to about 70 milliseconds on the 4G network), together with higher data transmission speed (about 100-fold from the current 10 megabit per second on 4G) by using higher frequency millimeter waves compared to existing networks. 2 , 3 All this increase in function occurs while it simultaneously reduces energy consumption by all the connected devices 4 by having low power requirements. However, because 5G transmits at higher frequencies, signal degradation becomes a greater challenge, and “base stations” need to be densely populated (approximately every 250 m). 5 Yet, such deployment provides unique opportunity to bring all those technologies locally to the point of care – and in real time.

However, a word of caution is needed. There are critical biological and physiologic factors of basic science that must be taken into consideration in developing and applying the new opportunities which the 5G ecosystem provides, especially for telemedicine – not all the capabilities of 5G can be leveraged at this moment, especially the huge number of healthcare related instruments and devices which are available on the IoT. Likewise, there are unique requirements within the domain of human interface technology (HIT) that must be investigated in order to optimize human use of the new communication capabilities; in addition, there are limitations and challenges in exploiting the communications spectrum. Finally, there are other technologies in addition to the Internet, such as AI, BD repositories, computational analytics (CA), supercomputers (including soon to be commercialized quantum computers) and factors involved in accessing and storage in ‘the cloud’ which dramatically impact the opportunities to exploit the new communications systems.

An existing and special use case is telemedicine, which is now well established and can be advantageous as it can provide more efficient and equitable distribution of healthcare when limited resources are available and patients’ transportation challenges might exist, all of which reduces unnecessary visits and exposure risks. Evidence of the effectiveness of this ecosystem will be presented in the review of the COVID-19 pandemic (below).

Finally, the sheer capacity of 5G combined with AI, and the capability to transfer data in order to accumulate and analyze BD, can be valuable in understanding the development of disease progression and improving forecasting capabilities. 5 Due to all of the above, 5G has been already adopted by a few centers across the world. 1 , 6 – 8

Although, telemedicine has been widely applied under different circumstances and applications, it faced several difficulties stemming from the limited latency and speed, especially in telesurgery applications which are reviewed below.

Therefore, this report is limited to reviewing the literature of healthcare application of the 5G which already exists and, after presenting the communication basic principles, to discuss future applications in the context of the other critical supporting infrastructures and biologic principles.

Search Strategy and Article Selection

All published studies regarding clinical applications of 5G were retrieved. The present study was conducted in accordance with the protocol agreed on by all authors was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. 9 , 10 PubMed (Medline), and Scopus (Elsevier) databases (last search: December 3, 2020) were searched using the following medical subject heading (MeSH) terms and text words based on the following search strategy:

Group A terms: “5G” OR “high bandwidth telecommunications”
Group B terms: “telemedicine” OR “telepresence”
Group C terms: “telesurgery” OR “teleradiology” OR “telepathology” OR “teleophthalmology” OR “teledermatology”

Group’s A, B, C and D terms were combined. Therefore, our search algorithm was as follows: (((((((5G)) OR (()))) AND ((((((((((((5G)) AND (telemedicine))) OR ((telemedicine))) OR ((telepresence))) OR ((telesurgery))) OR ((teleradiology))) OR ((telepathology))) OR ((teleophthalmology))) OR ((teledermatology)))))).

Inclusion- Exclusion Criteria

Of the articles retrieved through the above-described search strategy only those that met the following criteria were included to this systematic review:

Original papers were only included. Review papers that met the inclusion criteria were not included; However, their reference lists were used to retrieve any relevant study of any publishing date.
All articles should report at least one clinical example of 5G.
Articles conducted in the last 5 years.
Articles written in English language.

Additional limits were applied to restrict manuscripts to those related to human subjects.

Article Selection

Articles were retrieved when their abstract were judged to possibly meet the inclusion criteria by two independent reviewers (EG, RS). If either author suggested retention, the study was included. The process was repeated for abstract review and, again, if either reviewer suggested retention, the study was included. All the retrieved article titles and abstracts were screened for relevant manuscripts. A full text review of the selected relevant articles was made in order to detect the studies included in this systematic review. Moreover, relevant full text review and/or systematic review manuscripts were used to retrieve articles of any publishing date from their reference list and include them to this systematic review.

The PRISMA flow diagram of the search strategy is presented in the Figure . Note: Many other articles that supported the discussion and remainder portion of the manuscript were included.

An external file that holds a picture, illustration, etc.
Object name is LS-JSLS210060F001.jpg

Preferred reporting items for systematic reviews and meta-analyses flow diagram.

Data Extraction

A total of 40 articles were retrieved and screened (title/abstract) and two more were retrieved from other sources and their abstracts were assessed for eligibility. Twenty-four of those were unanimously considered as nonrelevant and were excluded from further analysis. From a total of 18 full text articles which were evaluated, five were excluded with other reasons and therefore 13 articles are included in this systematic review. The limited number of relevant publications emphasizes the lack of knowledge of and attention to these revolutionary technologies, and the opportunities for future implementation in healthcare.

The following data were extracted from each study: Author, publication year, Country, Type of study, Primary specialty, Participants, Results/Conclusion, and Remarks ( Table 1 ). As can be seen in Table 1 , the geographical location of the studies was mainly from China (8/13). Ten of the studies were clinical applications or at least had a clinical component using 5G technology.

Summary of Studies of 5G Medical Applications and Their Variables of Interest

1. Communication Basic Principles

5g technical parameters.

Currently, mobile data transmission is mainly based on 4G/LTE or on Wi-Fi. The 4G/Long-Term Evolution (LTE) offers a minimum signal delay of 20 ms mainly designed for internet (e.g., browsing and video streaming) which is well below that required for real-time integration of sensor data. Furthermore, Wi-Fi solutions are an alternative, but they can be interrupted by other users at any time due to unprotected radio bands. 11

The new 5G telecommunication standard offers high bandwidths as compared to the current mobile transmission standard 4G/LTE: 5G is a 100 times higher data transmission rate (up to 10GB/s), and, at the same time, an extremely low latency time (<1ms), and 1000 times higher capacity (bandwidth) with a high quality of service which is almost equal to the zero data response time in the real world. 12 Millimeter wave telecommunication is such an advantageous technology for 5G networks because it allows extremely high data transfer speeds (several gigabits per second). However, a large number of small cells with limited radius deployment must be used to achieve seamless and efficient coverage and form a 5G ultradense cellular network. The cells may be of different size, and they are classified as Femtocells, Picocells or Microcells. The massive multi-input, multioutput is an evolving technology capable to transmit multiple data beams at a time, thus increasing the throughput and spectrum effectiveness in both uplink and downlink. 13

Additionally, 5G requires up to 10 times less energy than the previous 4G/LTE mobile communications standard. 12 It is expected that the 5G network will have a 1,000-fold rise in traffic in the coming decade, although the energy usage of the whole infrastructure will be just half of today’s system's consumption. Therefore, this is a crucial factor for reducing the total cost of ownership, including the environmental impact of the networks. 13

The above mentioned qualifications meet the requirements imposed by many new digital applications like the interconnection between physical and virtual objects, the IoT, autonomous driving, 14 machine-to machine connection in industrial production, 15 as well as different medical applications that were previously technically impossible to implement. 16 The latter systems conform to the Ultrareliable low-latency communication protocol where a sub-millisecond latency with a response rate smaller than 1 packet loss in 105 packets is required for patient safety. 17

To achieve their goals, the industry reached a consensus to use emerging major technologies like network function virtualization (NFV) and software-defined networking (SDN). The most remarkable technology to simplify a healthcare network management is SDN, which takes apart the network control from the data forwarding plane. Thus, the control plane oversees the entire network below as well as the network resources by using a programmable Application Programming Interface (API) . 17

As 5G is expected to greatly influence our lives, its security is even more important than before. Two types of 5G network security are implemented:

Security using software such as firewall applications installed in the perimeter of any network, based on need.
AI-based security as it can sensibly identify the terminal actions and requirements on time to avoid service interruptions.

In order to further enhance the security one can also use security automation and Blockchain security assessment techniques. 17

The 5G network requires more complex antenna design and distribution in the space needed to be covered in order to achieve faster speeds and low latency. Therefore, specific antennas are proposed for the 5G network, also known as active antennas (in contrast to passive antennas used in 4G) which differentiate 5G network in terms of speed, latency, and security.

Recently, big international telecommunication companies have taken the lead in the competition for the upcoming 5G cellular technology, as it is thought to be their most important future source of revenue. It is expected that the 5G network will be broadly introduced as a simple framework for hyperconnected mobile devices and will ultimately evolve into a modern 5G platform. It should be noted, however, that there is currently no uniform 5G standard. For a detailed technical review of the architecture and security of 5G Technology, the reader can refer to reference. 17

Looking beyond 5G, the future generation of telecommunications (6G), is already in the late research and development (R&D) phases (Technology Readiness Levels - TRL 3–5), with an exponential increase in bandwidth and capabilities that will allow implementation of applications that even 5G cannot fulfil ( Table 2 ). This is especially important in the area of network security/privacy and maintaining Healthcare Insurance Portability and Accountability Act (HIPAA) 5 compliance.

Parameters of Current and Next Generations of Telecommunications *

With the current full life cycle development of a technology product from concept to commercialization at 10–15 years, it is likely that the 6G may be available within that time period, or perhaps slightly sooner. With integration of other advanced technologies, such as smart devices, composed of micro-electro-mechanical-systems (MEMS) sensors, AI and computational analytics on a single chip, automatic diagnosis can be immediately generated at the point of care (edge computing) and transmitted to a waiting consulting physician or directly to the electronic medical record. Another emerging area of 6G, will support virtual reality (VR), where a simulated presence is generated by computer graphics and allows users to interact with the simulated elements in a seemingly real way. Augmented reality (AR), where computer-aided information is generated and graphically augmented (overlayed) to the display real-time, can also have broad implications for healthcare. Counselling patients and preoperative consent can likely be enhanced with augmented reality, and nonclinical functions in hospitals such as navigation, in particular for visually impaired patients. 5 Both humans and machines will use 6G which will allow for truly immersive extended reality (XR) and high-fidelity mobile hologram which could have enormous implications for healthcare; but although the 6G networking will provide ample potential for VR/AR or even XR, the immersive experience of these alternative realities has yet to find a practical application within the clinical healthcare field.

Telemedicine

The most use of 5G networks in healthcare is currently Telemedicine, and when the world emerges from global COVID-19 pandemic, healthcare will become a hybrid medical practice of live’ face-to-face’ clinical care and telemedicine-based care.

The World Health Organization (WHO) has announced COVID-19 was a “pandemic” (World Health Organization,2020). With the nonlinear rapid disease expansion, COVID-19 has caused widespread healthcare, socio-political and economic impact. 18 – 20 Countries and healthcare systems around the world have been forced to rapidly adapt to telehealth and digital innovations to mitigate the impact of the risk of virus transmission to what is widely regarded as the “new normal”. The clinical adoption of telemedicine has been much slower (usually only used for special-use opportunities), however with this COVID-19 pandemic, there has been a surge in all digital communications.

Healthcare applications, especially telemedicine, has finally rapidly expanded, mainly because it enables physicians to remotely evaluate their patients. This can be advantageous for several reasons:

Telemedicine can assist to more efficient and reasonable distribution of constrained healthcare assets, by delivering support with innovative service design that already exists, to distant areas where there is a shortage of physicians and other healthcare professionals, by reducing travel transport challenges and the associated carbon footprint. Furthermore, in acute cases patients could receive immediate specialist input even if one is not available locally and access to care for both chronic and acute disease patients could be reduced while maximizing the quality of the telemedicine consultation.
During the COVID-19 pandemic, telemedicine is no more focused on only targeting remote regions, but it is rapidly becoming a new standard of care adopted by multiple centers across the world, as it enables triaging prior to patients’ arrival into hospital to avoid unnecessary visits and exposure risks. 1 , 6 – 8
Finally, the collection, storage and transmission of data offer the potential of combining telemedicine with AI and many other innovative technologies. When used prospectively with longitudinal data, vast swathes of new knowledge such as disease progression and real world, real-time incidence calculation could be harnessed. Moreover, this could grow into a consistent source of longitudinal data which would be valuable in the development of disease progression forecasting capabilities by training and incorporating AI.

2. Other Critical Supporting Infrastructures

Even as the Internet has been exponentially growing, and the communication systems (cabled and wireless) have likewise logarithmically increased, there are other parallel information-based technologies that have rapidly grown as well. In most cases, these technologies have developed in their own silo, usually due to inadequate communication systems to unite them. The emerging 5G wireless networks are finally providing the bandwidth, speed, and low-latency to act as a force to begin integrating these parallel technologies into an ‘information ecosystem’. What enables this huge increase is the change of the networking from connections by physical ‘wires’ (cables), to wirelessly distributing the network using software (software designed networks – SDN) and “network slicing”: an analogy of instead of ‘laying another wire or cable’, the software instead ‘slices’ the wireless network into different frequencies when a new connection is needed. This allows the integration of ‘other’ technologies, and most importantly the IoT which also supports robotics and sensor technology, BD acquisition, data repositories, AI, computational analytics, and supercomputing ( Appendix 1 ).

The new telecommunications networks are not only connecting human to humans but also connecting ‘smart devices’ (especially the 8 billion smart phones) of the IoT total of 14.2 billion devices now, with projections of 25 billion by 2025 and 60 billion by 2030. In addition, there is massive data acquisition continuously monitoring by microsensors from machines (devices, equipment, systems) or living systems including humans, most of which is machine to machine communication for maintenance and/or autonomous control – and all linked together using Global Positioning System (GPS) for precise geolocation.

Careful attention must be paid to the interface between the HIT that provides the final connection of the communication system with a person, be it the current video technologies, or any of the forms of VR, or possible future interfaces such as wearable contact lens displays, or the ultimate brain-machine interface. After all, this information ecosystem is a ‘system-of-systems’, with each link in the chain dependent upon the success of all others, that decisively results in success.

3. Fundamental Biologic Principles

When integrating any two systems, there are points of ‘connection’ (interface). With systems that are alike (for example machine or electronic connections), their interfaces are similar (physical systems) and the solution is relatively straight forward since both systems obey physical laws. However, when integrating two dissimilar systems (machine and human), the connection (interface) becomes much more intricate, since both the laws of physics and biology (which are radically different) must be accommodated. This integration is defined as HIT: a means or place of interaction between two systems; especially, the interface between people (users) and computers or devices. 21

The new advanced technologies, such as telecommunications, computers, imaging, etc., work at microsecond speeds; humans perceive and react milliseconds, so an interface must be built such that the human systems can be accommodated and enhanced (see Table 3 ) for the effect of how telecommunication latency can affect human performance). For example, the recent developments of 5G telecommunications that results in huge increase in bandwidth and speed with extraordinary low latency (∼ 1 ms) has the potential to extend the distance for safely performance of remote surgery (telesurgery). Conversely, there are human ‘systems’ which are extraordinarily complex such as the human neurosensory system (with 23 different types of nerve endings for sensing, at a density of 1000 nerve endings per cubic millimeter, in an average hand surface area of 4000 mm, each sending stimuluses at 1000 times/second), such that even recent exponential advances in microtechnologies and computation power are woefully insufficient to currently create high-fidelity haptics to provide the sense of touch for a safe robotic system for surgery. Examples of many other mismatches between human (especially the 5 major senses and the neuromuscular responses) and ‘machine’ are in Appendix 2 , thus emphasizing the need for greater attention (and research) in human interface technologies.

Human Performance (Laparoscopic Knot Tying) Compensation Under Conditions of Latency

4. Clinical Applications Using 5-G Wireless Networking

The current capacity of 5G telecommunications provide the perfect ecosystem to reassess care delivery and to adopt the synergistic and complementary digital technologies discussed above, incorporating AI utilization, and facilitated by 5G networks, IoT and BD and computational analysis. Below are some clinical applications of using 5G:

The following examples illustrate the large breadth of healthcare clinical services that can now be provided because of the emerging 5G networks.

Pulmonology

Up to now, there is conflicting evidence that telemedicine solutions help address chronic respiratory diseases. 22

However, a recent paper (see Table 1 ), profiting from the capacity to parallel several IoT applications due to the coexistence of multiple streams by 5G connectivity, presented a home telemonitoring system designed for chronic respiratory patients.

All data were streamed to an iPad which was connected via Wi-Fi to a 5G router and thereafter to the 5G infrastructure. The authors could access the data by means of a dedicated dashboard. The whole system was tested on 18 healthy volunteers during nonsupervised recordings lasting at least 48 hours. Due to the 5G bandwidth, the results showed that the system provided more complete and clinically relevant and real-time information than other previously studied telemedicine systems. 22

Medical Imaging and 5G

As a massive number of images accumulates and manual segmentation requires a lot of time, it becomes a big challenge for analyzing and diagnosing and furthermore, it may not meet the demand of analyzing big images data. 23 This problem is attacked by using automatic methods for sectioning medical images (SMI) to obtain any viewing angle via multiplanar reconstruction (MPR) by using a plethora of various technologies, for example, region-based methods, clustering methods, threshold algorithms, machine learning, and deep learning. 24

However, since each MPR’s interaction requires the reconstruction of the raw data, thus hundreds of megabytes of SMI data must be transferred, resulting in a higher requirement for network transmission via Internet without a bottleneck creation as well as a higher security risk of data leakage. 25 This is an example of the advantages and opportunity for 5G communication with Software Designed Networks (SDN) and ‘network slicing’ to more flexibly, efficiently and cost effectively provide enhance Intranet and Internet capability and security.

Of course, this is not the case for less demanding imaging such as echocardiography or dermatology images transfer, where effective transmission of high-quality images can be accomplished either through low-cost transmission systems or with images/video from publicly available apps. 26 , 27 The same applies to otolaryngologic exams, especially regarding remote of video-otoscopy images, as a recent review suggests that they can deliver adequate information suitable for diagnosis in most cases and results in high levels of user satisfaction. 28

Diagnostic pathology is mainly depending upon image quality. The conventional cytological glass slide examination is time consuming as only one person can view it at a time. Beyond the use of the static images in telepathology, dynamic telepathology has recently been introduced, where the transmission of microscopic slide images to the recipient is done in real time via live telecommunication. Furthermore, through the implementation of remote robotic control of the microscope, the consulting pathologist can also control the magnification, a feature extremely useful for interoperative pathological analysis. 29 The introduction of advanced, micro-miniaturized imagers, such as optical coherence tomography (OCT) and near infrared spectroscopy, are being introduced through gastrointestinal endoscopes, providing immediate ultrahigh-resolution images of intra-cellular structural pathology for the endoscopist, 30 which can be streamed live to the consulting pathologist and/or archived for future reference.

Remote Ultrasonography

Much interest has been shown in robotic-assisted teleultrasound and expert remote consultation. During this procedure, the operator manipulates a simulated robotic hand to remotely control the robotic arm at the patient end. An ultrasound probe is fixed on the robotic arm to scan the patient. Up to 2GB of ultrasonic image data from a lung ultrasound scan lasting a few minutes is produced and transmitted at high speed with low latency. The robotic arm is movable and easy to use, allowing clinicians to collect lung images directly and monitor patients remotely.

From a technical point of view, the network download rate is 930 Mbps and the upload rate of 132 Mbps, maintaining a stable level with latency being at 23–30 ms and the network jitter at 1–2 ms, thus allowing a smooth scanning by the robotic arm and an undetected time delay. No package loss was detected during all the procedures and thus the images quality transmitted to the attending physician had no visual reduction compared with those obtained by traditional on-site examination. Therefore, it is concluded that by breaking the temporal and spatial limitations due to the high bandwidth network, robotic-assisted teleultrasound succeeds in bridging the gaps between specialists and patients from remote cities. 31 This real-time image acquisition of robotic ultrasound across long distances has the following advantages:

Examiners can be protected from cross infection by remotely monitoring patients without any personal contact thus diminishing the number of those who come into contact with the patients.
Experts by using this technology can remotely perform real-time ultrasound scan on patients in distant locations, thus alleviating the pressure of shortages of medical resources.
The robotic ultrasound can be performed anywhere, at the patient’s bedside or even in the patient’s home. 32

As can be seen from Table 1 , there are three relevant articles using robotic teleultrasound lung scanning for suspected and/or declared COVID-19 patients, all originating from China:

The first article evaluated robot-assisted teleultrasound and expert remote consultation for early cardiopulmonary evaluation by performing lung ultrasound, brief echocardiography, and blood volume assessment in four patients hospitalized in isolation wards and the examination results were immediately delivered to the attending physicians. Furthermore, the authors report the use of this robot-assisted teleultrasound examination as a routine for evaluating acute abdominal diseases such as cholecystitis, appendicitis, pancreatitis, and urolithiasis. In addition, teleultrasound has been applied in focused assessment with sonograph for trauma (FAST) and extended FAST, musculoskeletal injuries, thyroid gland diseases, and subcutaneous soft tissue lesions. 31

The second article used a robotic ultrasound system, integrating remote robotic control, audio-visual communication and ultrasound examination, and assessed its feasibility in 23 COVID-19 cases. Furthermore, they established a standard examination and evaluation protocol as follows: A cardiopulmonary assessment completed successfully for all patients lasting on average 10 to 20 min. An ultrasound image contained information regarding distribution characteristics, morphology of the lungs and surrounding tissue lesions, left ventricular ejection fraction, right/left ventricular end diastolic area, pericardial and/or pleural effusion, and lung ultrasound score. Although they had excellent results in COVID-19 detection, they admit that the 5G robotic-assisted remote ultrasound system is still in its infancy, has several limitations (i.e. restrictions of the examination position of critically ill patients, limited operating angle of the robotic arm, use of only one ultrasound probe) and requires further improvements as well as multicenter trials to establish its feasibility as a valuable tool for remote lung pathology detection. 33

The third article of two cases discusses the advantages of using US versus chest CT for detection of lung abnormalities due to COVID-19, stating that limitations of CT are: a) difficult to perform on patients in critical condition who cannot be moved. b) CT is not available everywhere, and c) the enclosed environment of CT may contribute to the spread of the coronavirus. On the other hand, ultrasound has the advantages of repeatability, absence of radiation, and ease of use. Compared with ordinary ultrasound, 5G remote robotic ultrasound has the added advantages of protecting operators, alleviating the pressure of medical equipment shortages, and considerable portability. The authors conclude that 5G remote robotic ultrasound may become a suitable choice for diagnosis and monitoring patients with COVID-19 infection. 32

Ophthalmology

An excellent review summarizes the digital technologies applied across different countries which are expected to increase the clinical workflow of ophthalmologists. 5 It is exactly because the data-rich image requirements needed in Ophthalmology that 5G, IoT and AI are introduced for OCT and fundus cameras and algorithms which are changing ophthalmological service delivery. These technologies are expected to enhance the quality and continuity of eye care to all patients.

Recently, a 5G connected smartphone attached to a portable slit lamp provided a live streaming in real time of high enough quality to be used clinically, thus opening up even more potential for telemedicine and teleophthalmology in the future. 34

The implementation of these technologies remains challenging, including the validation, patient acceptance, and education and the training of ophthalmologists on these technologies. It is imperative that they must collaborate with technology experts and data scientists to achieve universal quality and sustainable ophthalmic services and continue to adapt to the changing models of healthcare delivery. 5

Interventional Cardiology

Robotic telestenting, in which percutaneous coronary intervention (PCI) is performed on a remotely located patient, availability of 5G could improve patient access to PCI, but has not been attempted over long distances likely required to reach many underserved regions.

In a recent study cited in Table 1 , telestenting performance was compared in regional (206 miles) and transcontinental (3,085 miles) distances from the interventional cardiologist. Ex vivo models of telestenting were used, and robotic PCI on endovascular simulators was attempted over both wired and 5G wireless networks and audio and video communications between the cardiologist and the simulation laboratory personnel were established over the network. A total of 20 consecutive target lesions in the regional model and of 16 consecutive target lesions in the transcontinental model were successfully performed. Outcome measures included procedural success, procedural time, and perceived latency. Procedural success was achieved in all lesions in both models. Latency was imperceptible in all cases in both models and the greater distance of the transcontinental model had not significantly different procedural times compared to the regional model for cases performed over wired or 5G-wireless networks. 35 This is the first study which demonstrates that remote robotic manipulation of coronary devices is now possible using wireless network connectivity.

Emergency Medicine

The emergency department (ED) is a good example for the widespread introduction of virtual triage via telemedicine, rather than coming directly to the ED in person. The patients benefit as they are not obliged to attend in person and can be treated with remotely delivered prescriptions. If they do need to attend, an appointment time can be scheduled more efficiently, being seen directly by the specialists rather than spending long hours in the ED waiting room. Additionally, with the maturation of chatbots, much of the patients counselling can be performed flawlessly through video consultation. Additionally, the healthcare providers benefit from the absence of physical attendance, the costs associated with additional time and space utilization, as well as the use of personal protective equipment. The healthcare personnel who can work from home can contribute to the efficient use of human resources at a time where sustainability must also be considered. Reduced in person ED visits also decrease the general workforce risk of COVID- 19, avoiding the highly undesirable scenario of transmission between clinicians and patients. 36 The safety and efficiency of remote triaging and automated counselling need to be evaluated, and until then, clinicians need to oversee each consultation as is standard process prior to the pandemic.

So far, in an attempt to make accurate diagnoses in emergencies, smartphones are used to take videos transmitted in real time to consultants located at a central hospital who then can assess the situation. 37 One such emergency is to estimate in real time the status of a fetus in utero through a cardiotocogram (CTG). However, it is used in medical care clinics only, and there are few reports attempting to send CTG data via a mobile network from home or from an ambulance to a medical institution. Several problems could occur and only one successful case has been published so far. 38 With the deployment of 5G this solution could be implemented as described in a recent publication, where the authors simulated the feasibility to concomitantly transmit not only CTG but also real time fetus US videos as well with excellent results. Thus, except CTG, the images during ultrasound examinations were high-quality videos on patient actors, which were transmitted without problems. 38 Thus, home monitoring of a fetus with the 5G system is a particularly useful application, which could create a new future for obstetric care.

While the practice of a surgeon is very much like the practice of general medical practitioner, the distinguishing feature is the amount of time committed to performing surgical procedures upon their patients. Surgeons do have the same clinical, educational, research and administrative requirements as all physicians, including the basics of history, physical, lab/imaging studies, outpatient and in-hospital care, discharge and follow-up. Likewise, in response to the COVID-19 pandemic, this includes the increased use of teleconsultation, teleconferences, etc., which is anticipated to be continued upon resolution of the pandemic. However, like all healthcare specialties, there are additional unique requirements and opportunities, which is the focus of the following surgical areas:

Pre-operative preparation
Intraoperative procedure, and
Postoperative follow-up (both in hospital and outpatient care).

1. Pre-operative Preparation

The surgeon meets the patient in the pre-anesthesia area and needs access to all the medical information from the medical record for review – which includes both medical data and medical images. If it is a complex procedure, many surgeons will not only have review of a full 3-D reconstruction of imaging studies (computed tomography [CT], magnetic resonance imaging [MRI], etc.), but may have also actually previously rehearsed the procedure using simulation, all of which requires real-time access to massive amounts of imaging data.

2. Intraoperative Procedure

More and more operations are being performed by minimally invasive surgery (MIS). Often, the video image is being captured, with the potential for sharing real-time with other surgeons or archiving. When used for educational purposes, high - bandwidth is needed for the transmission of the video image, along with audio for the surgeon to communicate with the learners in the ‘audience’. The archived video of the procedure can be used for many educational and administrative or legal purposes, including credentialling, privileging, or remediation. In addition, during surgery, the surgeon often will need to take a biopsy which is sent to a pathologist to be examined and reported back to the surgeon waiting for the results to complete the operation. New instruments now are able to capture the image of the pathology in real time and transmit the image directly to the pathologist for diagnosis, saving significant operative time. Telepathology can be in the same hospital, or literally anywhere around the world for consultation in difficult diagnostic cases. Another technology, data fusion, permits overlaying the live video image with additional images (CT, MRI, fluorescence markers, etc.) to guide surgeons with ‘X-ray vision’ to see structures and pathology within organs or lymph nodes (for cancer).

3. Postoperative Care (Including Outpatients)

The immediate postoperative care of a surgical patient has previously been done within an in-hospital stay, however the newer MIS procedures have allowed many patients with simple, uncomplicated surgical procedures to go home the same day. Teleconsultation to the patient’s home, especially during the COVID-19 pandemic, has exponentially increased. Not only is there the opportunity to speak to the patient by using a cell phone, but it is now possible to actually see the patient and use the phone (or any one of the many new ‘in-home’ medical devices to examine the site of the surgery, saving patients the need to come to the hospital for follow up. This capability for a visual examination is also in very high demand for many chronic nonsurgical diseases, especially for wound care and dressing changes.

Trauma and accident injury is a special needs surgical application because minutes to surgical care can be critical. Innovation in instruments, devices, procedures, and training, including the Advanced Trauma and Life Support (ATLS), has dramatically increased the lives saved. The new capabilities of communicating with an ATLS trained responder, especially in a telemedicine-enabled ambulance, can bring a sophisticated trauma surgeon’s consultation directly to a first responder anywhere. Because of the military’s need for (and research in) battlefield trauma care, it is anticipated that a significant increase in remote, telemedical care (including the possibility of remote telesurgical care) will be enabled by the scope of 5G communications.

Clinical Telesurgery

Telesurgery (or remote surgery) aims to break the obstacle of geographical boundaries in providing high quality healthcare in the most complex medical interventions and surgeries. High-qualified medical expertise will be transferred from the major hospitals to the decentralized ones with the use of remote-surgery, remote diagnostics and telemedicine resulting in significant cost reduction, and improved efficiency in health care services. Telesurgery, where parts of the procedure are controlled by a surgeon from a central site to a remote location, is the most demanding application among the remote healthcare services and thus by successfully validating this application, the validation of technology for the entire range of less demanding remote healthcare applications can be implied. 39

The domain of applications of remote surgery, apart from decentralizing health care, are remote surgical operations under extreme conditions, such as at the battlefield and remote operations in extreme environments like in space missions. Telesurgery entails the use of a master-slave robotic surgical system. Currently, the only Robot-assisted Minimally Invasive Surgery (RAMIS) system with FDA approval is the da Vinci surgical system, which has offered to surgeons’ a greater visualization, enhanced dexterity, greater precision and greater comfort; to the patients it has offered shorter hospitalization times, reduced pain and discomfort and faster recovery time.

As can be seen from Table 1 there are very few clinical reports using 5G for telesurgery. For example Remote RAMIS (telesurgery) has already had investigational testing in various scenarios and conditions. 40 , 41 The first true telesurgery on a patient was performed in 2001 between New York, USA and Strasbourg, France (∼6200 km apart); the so-called “Lindbergh Operation”. 42 The authors used a dedicated trans-Atlantic fiber-optic cable. The average round-trip delay was 155 ms including delays in image transmission, which made delay of movements executed by the surgeon in NY, apparent but easily managed within the 155 ms. Telesurgery has since been performed by other researchers. Anvari and colleagues 43 have reported the largest patient series with more than 30 remote operations between the central site located in Hamilton, Canada and the remote site in North Bay, Canada (∼400Km apart), over a virtual private network (VPN) on a nondedicated fiber-optic line. Reported average latency was 140 ms which was noticeable by the surgeon, who automatically compensated for the delay. It has been suggested that the ideal latency time for telesurgery should be less than 100 ms and that problems such as inaccurate manipulation could appear if the latency time is longer than 300 ms. 44 All aforementioned research outcomes do not include haptic feedback, which severely increases latency. It has yet to be tested whether future telesurgery systems will be able to integrate haptic feedback that is accurate and precise enough to increase the surgeon’s performance without increasing latency.

In order to implement remote surgery, we should address the critical technical challenges of robotic telesurgery, which are the minimization of latency between master-slave and the maximization of reliability, availability and security of the communication channel. The desired specifications are:

Latency (end-to-end round trips) of ≤ 100ms depending on the application.
Ultrareliable communications (“seven nines”).

The term ultrareliable can be quantified in terms of fixed-line carrier-grade reliability of seven nines i.e., an outage probability of 10 −7 , which translates to microseconds of outage per day. These specifications cannot be provided today by existing 3G and 4G networks.

The hypothesis is that 5G infrastructure offers the desired reliability and latency and therefore is an enabler for safety-critical applications such that remote surgery, from a central major surgical hospital medical center can be matched to a specific patient’s medical needs in a remote hospital location. In the more distant future, when haptic technologies develop to a safe level of precision and accuracy, these technologies can be applied to RAMIS telesurgery systems. It should be noted that the same infrastructure of haptics for telesurgery could be applied to other remote healthcare applications such as telediagnostic tools, which could be available anywhere, anytime, allowing remote physical examination which could include palpation. 45

As with all newly implemented emerging technologies like telesurgery, facilitation by the 5G network is a game changer. Highly delicate procedures like spinal surgery could benefit from high capacity, low latency. This also applies to other surgeries in other specialties like cardiac surgery, urology, and colorectal surgery. In short, the entire domain of surgical procedures could be enhanced with 5G enabled telesurgery.

Before 5G, only a few telesurgeries were reported which were carried out through a 4G network while mostly internet and satellite networks were previously used for telesurgery. 46 Thus, Wirz et al.. performed robotic telesurgery to complete a pituitary tumor resection on a simulated model over the Internet with a bandwidth of 1 Gb/s in 2015. 47 Regarding surgical applications our review revealed two preclinical studies: One article reporting 5G mediated nephrectomies in 4 swine, estimating the latency time due to long (300 Km) distance, 48 and another one operating in 5 pigs in a shorter distance (1–6 Km) 40 Rayman et al. performed robotic telesurgery to perform a left internal mammary artery dissection in pigs through a satellite network with a maximum bandwidth of 10 Mb/s. 49

Regarding remote telesurgeries, in USA, a surgeon from Texas, 1200 miles away from a Florida Hospital, remotely manipulated the da Vinci robot, performing operations on simulated patients through the Internet. In China, Hainan Hospital of Chinese PLA General Hospital and Beijing Jishuitan Hospital performed remote positioning for brain pacemaker implantation surgery and screw fixation surgery, respectively, through a 5G network. However, these surgeries do not require high demands on network latency and bandwidth of the 5G network as compared to the continuous manipulation and 3D video transmission in laparoscopic surgery. 48 , 50

While the future for telesurgery looks bright, there are a number of challenges that need to be addressed. The following are suggestions for research studies:

Both the surgeon console and the patient side cart need to be more compact or portable. Ultimately, the surgeon console could be as portable as a laptop computer and the patient side cart should be compact so that it can be placed in an ambulance or a mobile ward (En-route ‘damage-control’ surgery).
Surgical robots need to be combined with AI, capable to alert of dangerous actions during the operation (error prediction and hazard avoidance).
Protocols and responsibilities need to be clearly defined to define whether causation of errors is from device (robotic and/or telecommunication system) or surgeon control.
Communication corporations need to take measures to assign and guarantee enough bandwidth and high priority for telesurgery.
With network security is still one of the major challenges to telesurgery, a security guard system for the 5G network has to be designed and implemented (anti-hacking).

Telerobotic Spinal Surgery

It is well known that robot-assisted spinal surgery has been a popular and reliable surgical procedure. Furthermore, a recent meta-analysis showed that the accuracy of robot-assisted pedicle screw placement was significantly higher than the freehand method. 51

A recent study ( Table 1 ) in which 6 hospitals participated from 6 different cities in China, 5G telerobotic spinal surgeries for 12 patients were performed and a total of 62 pedicle screws were successfully implanted using the 5G telerobotic surgery system. 52 The operation time was 142.5 ± 46.7 minutes, and the mean guide wire insertion time was 41.3 ± 9.8 minutes without any intraoperative adverse events. They concluded that telerobotic spinal surgery based on the 5G network is accurate, safe, and reliable. The application of the 5G network in the clinical area has great potential and value in the future.

The authors also explored the new pattern of “one-to-many” remote surgery. Under this mode of remote surgery, one expert surgeon can simultaneously provide surgical care to more than one remotely located hospitals, something which previously was significantly restricted by the limit of network bandwidth. A “one-to-three” telerobotic surgery was successfully performed during this study, and it is believed that even more multicenter remote surgery is simultaneously possible, due to the vast potential of the 5G network. 52

5. Medical Education and Healthcare Research

Attention must be paid to the unique needs of both medical education and biomedical research, especially in this era of ‘evidence-based medicine’. Obviously, the equivalents are evidence-based education (a complete paradigm shift for education) and evidence-based research (an opportunity to improve speed and quality of research).

5.1. Medical Education

In the surgical specialties, technical training has changed from subjective mentored ‘see one, do one, teach one’ in the operating room, to objective assessment of performance with proficiency-based progression (PBP) training 53 in the simulation center. Assessment is enhanced by AI software, analysis of performance through computational analytics on the massive data acquired in the simulators and use for immediate, formative feedback. During the beginning weeks of the COVID-19 pandemic in Wuhan, China, there were over 800,000 accesses to the COVID-19 training database. After the pandemic, it is postulated that there will be increased emphasis on a new ‘hybrid model’ of medical education, with many of the advantages of just in time and remote learning enriching traditional educational models.

5.2. Healthcare Research

The new 5G information ecosystem greatly increases the productivity on both basic science and clinical research. First, the technologies greatly facilitate collaborative, multi-institutional studies and secondly through the access to massive data (BD), repositories, AI and computational analytic software. The data is frequently being fed autonomously from the billions of devices, equipment and instruments connected to the IoT.

Basic science research, especially at the cellular, molecular, genetic and “-omics” levels, produce vast amounts of raw data which previously was too large to share among institutions and researchers, let alone be processed by AI, computational analytics, and super computers. For clinical researchers, acquiring enough patients for large enough clinical trials to prove validity can now be accomplished through collaboration in near real-time because of available bandwidth inherent in the 5G telecommunications.

6. 5G and the COVID-19 Pandemic

When the COVID –19 pandemic broke out in Wuhan, China, the city’s healthcare system was rapidly overwhelmed. A disaster response was quickly established, including the new 5-G telecommunications networking. 54 In the first 29 hours, 3 ‘shelter’ ( fangcang ) hospitals of 4000 beds were created in empty stadiums and auditoriums, including a complete intra-net within the hospital and internet connecting hospitals globally, especially giving access to the internet of the existing 5-G high bandwidth wireless networks throughout all the city’s hospitals. 52 The intranet connected all the computers, smart devices (for example, Real-time Remote Computed Tomography (CT) Scanning on 152 patients with COVID-19), in addition to critical information systems (X rays, laboratory tests, Electronic Medical Record, maintenance, administration and wireless mobile phone) services immediately, without the need to spend weeks running cables throughout the hospitals. 54 Over the remainder of the week, an additional 13,000 beds were created using ‘cabin hospitals’, essentially standard ‘shipping containers’ that had previously been outfitted as individual departments of the hospital for beds and services. Simply connecting the various containers (cabins) together and instituting 5G networking, each department was assigned their own VPN using a software technique called “network slicing”. 25 The result of the huge 5G bandwidth was creating an additional 17,000 beds, all immediately connected (essentially no latency) throughout the city for standard telecommunications, teleconsultation for medical experts throughout the country, telereferrals for critical patients (a total of 425 emergency teleconsultations), and other healthcare services. In addition, AI was implemented in intelligent diagnosis of medical imaging and temperature measurement technology based on computer vision and infrared technology; while AI together with BD were used for epidemic situational analysis; tagging, contact tracing and monitoring of personnel movement as well as of positive cases; just-in-time logistics, inventory control, asset tracking and material allocation. In short, the availability of huge bandwidth significantly reduced the chaos of the disaster by providing real-time access and ‘visibility’ to all aspects of healthcare delivery. 55 An abridged version of the Wuhan response is contained in Appendix 3 .

7. Pitfalls of the Use of 5G in Healthcare

The technology of 5G communications bring great promise to significantly improve healthcare – from the technology standpoint. However, Medicine is as much an Art as it is a Science, and therefore what appears to be a very simple elegant technological opportunity, which healthcare providers really want and which will greatly benefit patients, there are often challenges from business, political, behavioral and other sources which can impede or thwart even the best of technologies.

Transforming an innovative idea to a commercial product is a long and arduous process, with about 10% of the ‘great new ideas’ being successful. During the 15–20 years (or longer) process there are numerous challenges and pitfalls. This is especially true in the high-risk, risk-averse conservative profession of healthcare, where resistance to change is uncompromising. Unfortunately, any innovation will usually be overhyped, and unable to meet expectations which is especially deleterious in the healthcare profession. Another critical pitfall along the way is, should the technology be completely successful, approval for reimbursement for using a device will be very difficult to establish, or will be established at an exorbitant cost. 56 Other reasons for lack of success are that inability to raise enough funding to complete the prototype to a commercial product, a poor fit of the device for clinical application, inadequate return on investment (ROI) and many other financial considerations. 5 Solutions to the technology transfer have been implemented at many academic and hospital institutions with establishment of “centers for Innovation” where dedicated Director, administrative staff, resources and funding, multidisciplinary teams with clinicians, engineers and other nonmedical fields work synergistically to complete the full life cycle develop of a new device or product. 57

Future Directions

A reflection on the enormous number of advanced technologies rapidly occurring in this new ‘Information Age’ emboldens the authors to make certain ‘extrapolations of known advancements in science’ to suggest ‘forward-looking statements’ about likely technology outcomes for the future. However, It is apparent that some of the emerging technologies, such as, 5G communications, AI, telemedicine (and telesurgery), automatic image interpretations, genetics, proteomics 58 , 59 and others are radically (and rapidly) changing the practice of medicine. Two areas need to be addressed: The core technologies in 5G communication, that are supporting most every industry and the healthcare specific technologies for medical needs.

The assumption is that the 5G and subsequent generations of wireless communication technologies will provide service now and in the future with exponentially increasing bandwidth (for data/information flow), decreasing latency (for real-time, near-real-time or just-in-time requirements) and with reliability/availability (the “seven nines” 99.99999% reliability), usability (simple human/machine interface), accuracy (received/delivered to the correct person/location), and especially security/privacy. The second assumption is that while the transmitting and receiving of information must obey physical laws, the interfaces (devices) for humans must obey both physical laws and biologic limitations [Note: machine-to-machine interfaces only obey physical laws].

Finally, attention must also be paid to the type of ‘supporting technology’ requirements, such as AI to enhance human intellectual performance in solving problems, supercomputers and BD repositories, sensors/actuators and MEMS on the IoT for data acquisition, etc., which are driving the need for better communication networks.

Surgery is in its fourth generation (Open surgery, endoluminal surgery, laparoscopic surgery, and now robotic surgery) with the emerging fifth generation of surgery being directed energy. The trend is for less invasive procedures (endoluminal) through natural body openings (mouth, nose, rectum, ears, etc.) to perform surgical procedures. This has been followed by and today the newest generation is robotic assisted minimally invasive surgery (RAMIS). Postoperative follow-up visits are being performed with teleconsultation. Until now, only a few “remote surgeries” (telesurgeries) have been performed because of the connecting cable between the surgeon console and robot arms. It is anticipated that the wireless 5G networks, with huge bandwidth and low latency, will lead to more implementation of telesurgery.

CONCLUSIONS

The newly emerging advanced healthcare ecosystem which is being totally integrated through the high bandwidth of 5G communications is truly disruptive. In spite of the limited deployment of 5G at this time, new clinical application examples clearly illustrate the opportunities across all healthcare specialties, including the administrative and nonclinical applications solutions for cost savings and improved efficiency. The larger the bandwidth and the lower the latency, the greater the number and size of the enabling technologies; in turn, this increases the demand for more telecommunication capabilities, thus creating an ever escalating upward spiral of growth.

This ecosystem of innovations has also created a milieu ripe for telemedicine to thrive and expand, as evidenced by the response to the COVID-19 pandemic, which has hastened the rapid increase of telemedicine and awareness of the importance of these digital technologies. Evidence from the pandemic has revealed the utility of telemedicine. Physicians must continue to adapt to the ever-changing models of care delivery and collaborate with broader teams involving technology experts and data scientists to achieve universal quality and sustainable healthcare services.

Two of the great innovations of 5G are software designed networks (SDN) and bandwidth “slicing”, especially for in-hospital networking. However, some of the technology limitations and challenges to be faced include mismatch between new communication capabilities with human limitations (solution: attention to human interface technologies), and the nontechnical limitations of behavior, politics, equity, cost, access and availability. Finally, two common technologies which are not ready (without revolutionary discoveries) are haptics and virtual reality, both of which are truly still in their infancy.

The good news is that this is still just the beginning of a great new revolution in digital healthcare with unlimited opportunities for growth.

APPENDIX 1. Other Critical Supporting Infrastructures

Although the 5G communications infrastructure is a major driver for healthcare innovation, it is the interaction among multiple other technologies that empower each other, well beyond the single contribution of each technology. It is the IoT - devices that are mobile, or location based, consisting of microchips of sensors, actuators, transmitters and/or receivers, other MEMS and (soon) nanotechnologies that provide the input or output at either end of the communication network.

Recall the beginning of modern remote communication systems (radio, telegraph, and telephone systems), that it was only when there was ubiquity of the transmitting and receiving devices that the telecommunication infrastructure flourished. So too, with 5G (and the follow-on generations of communication systems) that only with addition of IoT for the input/output, AI to make processes ‘smart’ and ‘autonomous’ (or semiautonomous), and BD repositories (the Cloud) with supercomputing (eventually quantum computing) running sophisticated algorithms with computational analytics, that created the need to innovate even more to keep up with the ever-increasing demand for more capable communication infrastructure.

It is the interdependence of this escalating upward spiral of innovation that continues to stimulate and challenge communication networks, and hence the need to interact with other technologies to sustain growth. But do not forget the interface between the human and the technology that provides the final connection of the communication system with a person, be it any of the forms of VR, wearable contact lens displays, or the ultimate brain-machine interface. After all, it is a ‘system-of-systems’, with each link in the chain dependent upon the success of all others, that decisively results in success. Below is a sampling of many (but not all) of such systems.

THE INTERNET OF THINGS

The internet of things (IoT) is composed of an estimated of number of 14.2 billion connected devices (of which 5.2 billion are unique cell phone users), with more than 21 billion connected devices by 2025, compared to the 8.2 billion global population as of Jan 2021. 3 In addition, there an unknown number of machine-to-machine connections, many of which are used for autonomous machine/device maintenance. There are more devices and machines talking to each other than people communicating, machines that are sharing information and automatically adjusting themselves. Although many machines used by humans are used for human-to-human communication over the internet (e.g., computers, cell phones), the machines/devices with their sensors, and receivers/actuators, and data storage, are going about their ‘businesses” without human intervention. There is certainly oversight of these machine activities, however the overwhelming mass of data (BD) is beyond human comprehension and sophisticated software of computational analytics is needed to for humans to have all that data to be converted into information relative to a person’s needs. As people begin using more and more wearable or embedded microdevices for health monitoring, there will be a logarithmic increase in generated data which will eventually connect every aspect of an individual’s life. In addition, possessions such as automobiles, appliances (stove, refrigerator, etc.) and other aspects of the ‘smart home’ that are currently attaching to the IoT will be seamlessly integrated into IoT. The new 5G network can accommodate this initial increase data flow, with the expectation that 6 generation (6G) and later networks will also exponentially increase communication to accommodates needs. For example, the IoT is estimated to increase to about 500 billion new “things” by 2030 (about 60 times greater than the global population), which is about the same time that 6G network is expected to be commercialized. 61

The integration of human and machine generated data will radically change healthcare services. In order to accommodate these healthcare needs, an entire communication infrastructure integrating the IoT, BD repositories, AI, supercomputing, innovative computational algorithms, edge computing (microsensors which include processing at point of data acquisition data, etc.) will be needed to form a ‘telecommunication ecosystem’, which not only be able to archive, monitor and optimize current activities, but also be used longitudinally to estimate future trends in personalized medicine, as well as overall healthcare services. The opportunities in telemedicine and telesurgery are reviewed in their sections. Additionally, the 5G networking will allow for reduced latency, and less dependence on network bandwidth and availability, and potentially enhanced security. 5

At the moment there are research projects 62 investigating such potential systems. In the distant future, there is the possibility that the bathroom will also become extensively populated with all types of sensors for automatic daily monitoring health status, providing a complete physical examination every day to update health status on a daily basis, while the person is simply performing the normal daily bathroom activities.

ARTIFICIAL INTELLIGENCE, MACHINE LEARNING, AND DEEP LEARNING

As a practical definition for this manuscript, AI is: “technology which mimics human behavior”. 63 Two areas (subfields) of AI have drawn attention in healthcare:

Machine Learning: Algorithms which can automatically learn rather than be programmed, and is the principle source for predictive analytics, especially for clinical practice and speech translation; 64
Deep Learning: The discovery of underlying ‘features’ and ‘meaning’ (such as cause and effect) in data from multiple processing layers using neural networks, mimicking the process used by the human brain. 65

In healthcare, DL is the best infrastructure for speech recognition 66 as well as in image recognition i.e. automatic presumptive diagnoses of known diseases from various imaging technologies, such as X-Rays, CT, MRI, OCT, etc. 67 , 68 At this time, AI has not reached a point of being able to independently perform diagnose and manage patients without human input. Currently, human review of all AI image interpretations requires clinician review, which provides a clear difference between autonomous and assistive AI.

BIG DATA, QUANTUM COMPUTING, AND COMPUTATIONAL ANALYTICS

The original process for the internet was: INPUT (Raw data typed in from a computer); TRANSMIT (communication over dedicated land lines via local area network (LAN)/distant wide area network (WAN); OUTPUT to a receiving computer (for storage and processing). The present status is MULTIPLE TYPES of INPUTS of data acquisition (see IoT), TRANSMIT (massive data over lines and wireless communication) for MULTIPLE TYPES of OUTPUT (massive “Big Data, to storage, streaming, computing with sophisticated algorithms for AI, etc.). The result of the Input and Output sides is an explosion of data that requires very wide bandwidth with decreased latency, accuracy, reliability, privacy and security.

VIRTUAL REALITY (VR), AUGMENTED REALITY (AR), MIXED REALITY AND EXTENDED REALITY (XR)

The original mobile phone-based AR/VR game applications (like Pokémon) were among the first types of practical apps on 4G. Now 5G networks, and in time 6G, will be able to support fully immersive VR. Rather than a graphic overlay of a real image of AR, the entire display (mobile phone, computer, etc.,) are replaced by an entirely simulated computer-generated graphics which provides the sense of “presence” in an imaginary “world”. Through a variety of ‘interfaces” (input devices) users are able to interact within the simulated world in a somewhat natural way. In AR, a graphic image, which is then fused in real-time to the display, especially to provide useful healthcare information, such as blood pressure, oxygen levels, positions of tissues and organs during surgery, etc. As a generalization, full VR is implemented in simulation and training, whereas AR is most advantageous for clinical care. Important tasks, such as counselling patients and preoperative consent can likely be facilitated with AR, and nonclinical functions in hospitals such as navigation aids for visually impaired patients. 9

These ‘realities’ still remain in their infancy and have only few applications in healthcare (principally in education and training, using online information or in training labs with simulations/simulators). [Note: There are currently over 100 certified ‘simulation centers’, in major hospitals and medical schools]. However, once their implementation of virtual worlds, simulations and applications become practical, reliable and of high visual quality, there will be significant demand for high bandwidth with minimal latency for remote learning and training.

APPENDIX 2: Fundamental Biologic Principles

One of the most overlooked issues in healthcare (and most other industries) is the capability of humans to adjust to a new technology – physically. While everyone is personally aware of ‘ information overload ’, there is scarce attention paid to the principal characteristics of the ‘biologic systems’ which humans use with technologies: Nervous and musculoskeletal system (brain/muscles), vision (eyes/imaging), hearing (ears/acoustics) and touch (hands/haptics); the senses of taste and smell play a relatively small/focused role, especially in interacting with technology.

The science of HIT is defined as “a means or place of interaction between two systems a means or place of interaction between two systems; especially, the interface between people (users) and computers or devices. 21 In order to address important new technologies (such as rapidly expanding communication technologies), consideration to the capabilities and limitations of the ‘human’ systems’ is important in order to optimize the devices to enhance human capabilities. Table 2 gives an example of typical human capabilities in regard to human performance related to perception and adaptation to latency in communication systems (earlier unpublished data by the author [RMS] but consistent with the average robotic knot tying in ‘box trainer under varying amounts of latency) and within the same range as the data stated by Anvari 69 under conditions of real time patient surgery. Recent long distance telesurgery case reports using 5G have stated latency much less than 200 milliseconds (ms), indicating that safe telesurgery is likely to increase with the use of 5G networking; however, larger validation studies are required. Another different example of human capability limitation is, although most persons claim to multitask at many different cognitive tasks simultaneously, 70 the literature indicates that the frontal lobe (the attention center) can only perform 3–4 tasks at once. 71 The explanation of the difference is that some authors considered automated functions which are controlled by the cerebellum and system of reflexes (such as when riding a bicycle, a person does not focus their attention on each leg and pedal when riding) or situational awareness, as part of multitasking. In addition, performing more than 2 cognitive tasks simultaneously results in increase error and decrease efficiency. Thus, when a person multitasks, there will be a HIT mismatch of massive data input overwhelming focused cognitive ability of the brain to process it, thereby decreasing performance and safety.

For the vision systems, will more new devices be developed using nanochip technologies, such as the ‘smart contact lens’, 72 that can receive massive data to extend human vision beyond the visible spectrum; and if so, what will be consequences of such capabilities?

Or perhaps the reverse is an important issue for the sense of touch: on a fingertip there are 23 different sensors, at a density of 1000 nerve endings per cubic millimeter, in an average hand surface area of 4000 mm, each sending stimuluses at 1000 hertz/second. Even with 5G or 6G (see Table 3 ), will there be enough bandwidth to transmit in real time that massive amount of data per second (in addition to all the other massive data flow from all the other systems in the milieu for surgery) and their interface to the input device (hand controller) for a robotic surgeon to precisely perform a complex surgical procedure?

Such examples beg the issue of defining accurate human performance measures to enable new technologies to accurately be designed and developed that match human needs. Such mismatches can result in too much data overload, or insufficient sensory input which results in loss of accuracy and precision and errors. The biologic complexity of human performance is well beyond the complexity of man-made systems, and therefore the regulation of data flow, even as large as the 5G systems, needs to be modulated to match the capabilities of the human. Therefore, HIT is an area of research that requires much more attention in order to optimize both the mechanical devices and the communication system.

APPENDIX 3. Use of 5G IN Wuhan China during COVID 19

As the restriction lockdown emerged globally due to Covid-19 pandemic, a sudden strain occurred on existing cellular networks: Healthcare, education, work, and most other human interactions were suddenly pushed onto the virtual arena. It has therefore been shown that telemedicine is not reserved only for the remote and underserved, but it can routinely serve the wider population as it has been shown to be safe, efficient, and inclusive, provided that measures to ensure security, robustness and capacity, particularly in densely populated regions with massive competing demands for bandwidth. 54

While the COVID-19 disease, initially discovered in Wuhan, China in Dec 2019 is well known, what is of specific interest is that the pandemic is one of the earliest examples of emergency use of 5G technology for many of the important applications for healthcare, not only as a communication tool, but also as a fundamental infrastructure to provide the necessary systems integration among the multiple informatics technologies.

Telemedicine had been available for decades, however only used in a small number of specific medical applications, in part due to limited capabilities of the communication networks – everything changed with the Covid-19 pandemic. Lockdowns were initially instituted within China with such a resounding success in Wuhan, that as the pandemic spread globally, lockdown followed. Without 5G, the existing 4G networks were insufficient because businesses, education, research, healthcare and personal (especially family) communications all battled for a share of the limited bandwidth. 5

The criticality of using multiple information-based technologies is documented by Ye, Zhou and Wu 60 in their report of the informatics technologies used and the experience gathered in responding to the COVID-19 epidemic in China through the perspective of health informatics. Due to the pandemic, the so called “5G+ Health” has moved from the experimental to the clinical phase. A plethora of technologies, including cloud computing, BD, the IoT, mobile internet, AI, and 5G mobile network, were used for epidemic prevention and control in China. Taking full advantage of mobile internet and 5G technologies active internet health care services provided by clinical experts from all over the country has been realized, both within the hospital as well to many essential supporting services outside of the hospital. More specific examples include the fact that citizens were able to access real-time epidemic situation dynamics and prevention knowledge through the mobile internet. BD were used for epidemic situational analysis; tagging, contact tracing and monitoring of personnel movement as well as of positive cases; just-in-time logistics, inventory control and material allocation. AI has been implemented in intelligent diagnosis of medical imaging and temperature measurement technology based on computer vision and infrared technology. By increasing bandwidth and reducing latency, telemedicine based on 5G technology has also played an important role in the consultations and treatment of patients with severe COVID-19 and in facilitating international cooperation.

The above-mentioned clinical information systems deployed have the following 3 advantages as described by Chen S. et al. 36 in the description of the physical and functional attributes of an entire emergency hospital network:

“A rapid deployment: The first three shelter-hospitals (called fangcang hospitals) in Wuhan with 4000 beds were built in 29 hours and their clinical information systems were deployed within this time framework.
An online information exchange among medical institutions in the external network (especially each fangcang hospital’s connection to their ‘host’ hospital)
A rapid response of electronic health records (EHRs) to specifically respond to COVID-19.

It is interesting to note that not only were the fangcang shelter-hospitals established within existing available large structures (e.g., stadiums, auditoriums, warehouses) within record time, but within the same time frame, an entire 5G wireless network was established throughout an entire fangcang shelter via software designed networks (SDN) with ubiquitous distribution and access through ‘network slicing’ of the massive 5G bandwidth, but was also linked to the nearest ‘host’ hospital for global access. Therefore, it is possible to use information technology over 5-G networking to increase the near instantaneous acquisition, communication and distribution of information for clinical purposes, but also as important, to provide transparency of information about an epidemic to reduce public panic and enhance public confidence.

Experience from a multimodal telemedicine network in Sichuan Province in Western China 55 using a newly established 5G service, a smartphone app, and an existing telemedicine system during the COVID-19 pandemic. Three applications were developed:

Physicians Tele-Education about COVID-19: More than 800,000 person-accesses have been implemented on prevention and control of the disease.
A 5G Dual Gigabit Network and a Multidisciplinary Medical Team: 424 remote consultations were conducted through a new real-time video telemedicine system for consultations focused on severe and critical COVID-19 patients.
A 5G Dual Gigabit Network and Real-time Remote CT Scanning on 152 patients with COVID-19 under the control and guidance of the host centrally located hospital. This commemorates the transition of telemedicine from the traditional consultation mode to a practical operation mode, ensuring high-quality CT even in areas with severe shortages of qualified personnel.

The authors comment that although telemedicine clearly has a wide range of potential benefits, it also has some disadvantages like the occurring breakdown in the human relationship among health professionals and their patients; and some issues concerning the quality of health information; and organizational and bureaucratic difficulties. However, the 5G technology and improvement in the management experience of telemedicine by policymakers, the abovementioned limitations can be minimized, and telemedicine may become a sustainable, mainstream solution for both public health emergencies and routine medicine.

In this case report, 55 the experience of accomplishing the IT infrastructure of 20 cabin hospitals in in Wuhan, China, to receive patients with mild symptoms within 48 hours is described. The cabin hospitals were largely engaged in blood and PCR testing, mobile CT scanning, and oral medicines administration. In order to complete the IT system construction within 24 to 48 hours, it was necessary to interconnect the cabin hospital within an existing hospital’s information network. A 5G all-wireless solution to divide the overall network system of the cabin hospital into multiple network units (i.e. the electronic medical records, a picture archiving and communication system, the laboratory information, the maintenance system, and other management information systems) was implemented and each unit was independently connected to the host hospital’s data center over a VPN capable to accept authenticated connections built on the 5G wireless network. The network bandwidth was about 10 times faster than 4G, and that the intranet bandwidth exceeded 50 MB, thus successfully conforming to the prerequisites demand of the network. Thus, all data, plus the Internet-assisted medical system of the host hospital, were integrated and built a lightweight wireless information system for the cabin hospital.

The outcomes of this approach were: a rapid system construction (within 48 hours for the system functional integration with the host hospital), zero maintenance of network and terminal devices (as remote maintenance software was installed on each computer), reduced chance of cross infection (as the whole information circulation was all electronic and paper was rarely used) and this implementation allowed minimum physical interaction of the healthcare personnel with the patients.

This networking mode is suitable for any emergency scenarios where an intranet connection to the host organization is necessary to set up within a short time. There is a bright future of 5G wireless network to dwarf the conventional wired network. Additionally, the proposed solution can be used for the multihospital network interconnection and rapid network recovery during the failure of wired network.

Disclosure: none.

Funding sources: none.

Conflict of interests: none.

Contributor Information

Konstantinos E. Georgiou, 1 st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Evangelos Georgiou, Medical Physics Laboratory Simulation Center (MPLSC), Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Richard M. Satava, Professor Emeritus of Surgery, University of Washington, Seattle, WA.

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Feature Article: S&T Report Peers into the Future of 5G & 6G

Since the introduction of the first cellular network in the late 1970s, few, if any, technology areas have advanced as quickly as the mobile phone. In just 40 years, cellphones have gone from voice-only, analog devices plagued by poor connections and lax security to the high-powered computers that can connect people and places across the globe. While consumers are more focused on their immediate needs, researchers and telecommunications companies are already looking ahead to the next 40 years of innovation.

Taking a similar long view in the fast-paced technology world helps organizations and their leaders in government and in the private sector gain a clearer view of the future direction, uses, and even risks of soon-to-emerge technology.”

To that end, the Science and Technology Directorate (S&T) recently completed an in-depth study that gives interested stakeholders some insight into the ongoing rollout of fifth generation (5G) networking technologies and the early development of the sixth generation (6G).

Titled “ 5G: The Telecommunications Horizon and Homeland Security ,” the report’s forward-looking scan uses the current state of 5G technology to preview the expected development of added enhancements like 5G Advanced and the next-generation 6G capabilities. More importantly, the report details relevant implications—opportunities, risks, and uncertainties—for the homeland and stakeholders across industry.

“Government and private-sector leaders should understand 5G’s current and expected impacts and how 6G is likely to develop if they want their organization to be poised to capitalize on each technology’s enhanced capabilities,” said Dr. Mark Fry, S&T’s senior tech scout. “This report provides insight on still-emerging 5G technology capabilities and opportunities, as well as the new capabilities that will be introduced by 6G. It is a must-read for leaders who think strategically about their organization’s future communications and connectivity capabilities.”

This image depicts 5G/6G Development Over Time. It states that 6G will contribute to fill the gap between beyond-2020 societal and business demands and what 5G (and its predecessors) can support. Graphic illustration of development of 6G over time. Large green arrow marked from left to right with increments of key developments, starting from: 2.4Kbps, 1G, voice calling, 1980; 64 Kbps, 2G, SMS, 1990; 2Mbps, 3G, Internet, 2000; 100-1000 Mbps. 4G, Internet of Applications, 2010; 1-10 Gbps, 5G, Massive broadband and Internet of Things, 2020; 6G, Towards a Fully Digital and Connected world, 2025-2030. Illustrations for 6G milestone include icons of a drone, virtual reality goggles, robotic arm, “green” car, and medicine via cloud. Terminology at 6G milestone includes New Spectrum. Disruptive Technologies. Cell-less networks. Disaggregation and virtualization. Energy Efficiency. Artificial Intelligence. The image’s source is Navixy.

Opportunities, Risks and Uncertainties

The continuing development of 5G and the defining of next generation 6G networking technologies will introduce a range of opportunities to enhance the mission capabilities of DHS and the homeland security enterprise, as well as associated risks and uncertainties to consider. Following are capsules about each area.

Opportunities

The report notes that opportunities for DHS and other homeland security enterprise organizations include new and enhanced capabilities supported by 5G and 6G networking infrastructure that will enable an expansion of connected devices and the realization of the internet of things (IoT) on a massive scale. Combining the massive IoT edge computing capability with lower data latency and enhanced mobile broadband experience, 5G networks are rapidly paving the way for deployment of autonomous systems like reconnaissance drones and support the strengthening of the communications infrastructure, including systems used by first responders.

“The proliferation of millions of wireless sensors could accelerate DHS missions already supported by remote sensing, detecting, and tracking devices. Relevant use-cases include enhanced surveillance capabilities along U.S. borders, at government facilities, and in response to emergency events,” the report notes. “These capabilities all are enabled by 5G’s capacity to connect billions of communicating devices that could help make mission-focused IoT possible for DHS,” the entire homeland security enterprise and other government departments and agencies.

Turning to the expected benefits of 6G, the report notes that since significant bandwidth is needed to continuously collect and transmit information in a mobile network, the next-generation networking technology’s wider bandwidth could enable a complex sensing network to support DHS’ diverse missions at the border, at ports of entry, and in hazard detection, disaster alerts and responses, and many other use-cases.

This image is a map showing global deployment of and investments in 5G networks. Areas marked with dark blue represent countries where 5G networks have been launched including in the U.S., Canada, Australia, New Zealand, Japan and most countries in South America. Light blue areas represent countries where 5G technology has been deployed including in Russia. Light green areas represent areas where investments in 5G have been made including in Greenland, India and Mexico. The image’s source is the U.S. General Services Administration and date is as of June 2021.

As with most things in life, the good comes with the bad and organization leaders must consider how to address the downsides. In this case, the S&T horizon-scanning report notes the bad comes in the form of increased risks stemming from information and communications technology (ICT) supply chain vulnerabilities, an increased network attack surface stemming from mobile carriers’ adoption of Open Radio Access Network architecture, and an increasing reliance on mission-critical services supported by 5G and 6G infrastructure. Together these risks threaten homeland security, economic security, and other national and global interests that will continue to evolve through the transition to 6G, the report states.

For instance, undue influence from nation-states in standards development can negatively affect the competitive balance with the ICT market, potentially limiting the availability of trusted suppliers and leading to a situation where untrusted suppliers are the only market options.

Additionally, 5G networks are an attractive target for criminals and foreign adversaries to exploit for valuable information and intelligence and this weakness may become more acute with the deployment of 6G, the report states.

Uncertainties

A future-scan normally will include uncertainties and this report is no different. After all, not all aspects of future network technology are settled this far in advance, especially with 6G. As a result, uncertainties regarding 5G’s further development necessitate DHS, other government organizations and homeland security enterprise entities to consider how various scenarios will impact their mission over the next five to 10 years.

The future of 5G/6G network resiliency, security, and 6G standards development currently is uncertain and both factors face multiple potential scenarios that will be important for DHS and other organization leaders to monitor to inform future decision-making.

For instance, in a scenario where the U.S. leads development of 6G standards the effort will result in a global, unified standard that meets U.S. and other countries’ concerns for security standards and economic competitiveness, while enabling global market access to U.S. firms. However, if bifurcated 6G standards are created, where other countries create their own incompatible standards while the U.S. and its allies move forward with separate standards, a fragmented matrix of differing standards globally will result in operational and threat-based implications that U.S. organizations—government and private alike—will need to adapt to during deployment of 6G.

“The future of 5G and 6G networking technology will deliver capabilities to DHS and the homeland security enterprise for enhanced mission effectiveness, but their rollout is still in flux. Organizations must balance adoption of these capabilities against the risks and uncertainties in play with both technologies,” said Dr. Fry. “The S&T horizon scan will help organization leaders to create their roadmap for secure implementations of current 5G capabilities, future 5G enhancements, and 6G technologies.”

For more in-depth insight on the opportunities, risks, and uncertainties of 5G and 6G networking technology, visit S&T’s 5G/6G Horizon Scan page. Visit the Technology Scouting page for additional reports and information about S&T’s related processes. For media inquiries, contact [email protected] .

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Conclusion et perspectives Réseaux cellulaires de cinquième génération ou 5G

Auteur(s) : Loutfi NUAYMI

Date de publication : 10 mai 2016

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6. Conclusion et perspectives

Au moment où la 4G commence à être utilisée à grande échelle, la préparation de la génération suivante de réseaux mobiles, la 5G, est très active. Des travaux exploratoires dans plusieurs régions du monde ont permis d’identifier les briques technologiques principales de ce système qui devrait être utilisé vers 2020. Dans la continuité de la 4G et d’innovations importantes, telles que l’utilisation des petites cellules et notamment les femtocellules, le système 5G devra fournir des performances encore meilleures que la 5G et pas uniquement au niveau du débit de données.

Dans cet article, nous avons résumé les principales technologies envisagées pour la 5G, après avoir décrit le contexte et le calendrier prévu pour y parvenir. La standardisation spécifique de la 5G démarre en 2016 et le travail est loin d’être terminé. De nouvelles contributions dans ce système complexe appelé à répondre à de grands enjeux sont prévues. De nouveaux services, certains envisagés aujourd’hui et d’autres peut-être totalement insoupçonnés pour le moment, seront assurés avec les réseaux 5G. Selon les prévisions actuelles, ils relieront en 2025 des dizaines de milliards d'équipements de toute sorte (téléphones, machines, objets...). Il reste encore beaucoup à faire, entre autres des efforts de recherche, nécessitant des collaborations étroites entre différents acteurs.

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BIBLIOGRAPHIE

(1) - CISCO White Paper - Cisco visual networking index : global mobile data traffic forecast update, 2014–2019, - fév. 2015.

(2) - BOLLA (R.) et al - Energy efficiency in the future internet : a survey of existing approaches and trends in energy-aware fixed network infrastructures. - IEEE Communications Surveys and Tutorials, Q2 (2013).

(3) - SUAREZ (L.), NUAYMI (L.), BONNIN (J.M.) - An overview and classification of research approaches in green wireless networks. - Eurasip journal on wireless communications and networking (2012).

(4) - HUAWEI - 5G : A technology vision. - White paper, fév. 2014.

(5) - ERICSSON - 5G radio access. - White Paper, juin 2013.

(6) - ITU-R M.2134 - Requirements related to technical system performance for IMT-Advanced radio interface(s), - ...

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1 - GÉNÉRATIONS DE RÉSEAUX CELLULAIRES, POURQUOI EN FAUT-IL UNE NOUVELLE ?

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How Edge Computing and 5G will Help IoT?

Edge computing & 5G are two of the most essential technologies & the mixture of these two technologies has a high potential to transform the way IoT devices work, causing them more efficient, faster, & more reliable. In this article, we will examine how edge computing and 5G will help IoT.

What is Edge Computing?

A distributed computing paradigm known as edge computing enables data processing and storage to be carried out near the data sources, such as IoT devices, sensors, and mobile devices. This strategy aims to minimize latency, decrease bandwidth usage, & enhance overall performance & security. It can only happen by processing & interpreting data locally instead of transmitting it to a centralized cloud or data center.

Edge computing architectures generally involve a network of edge nodes, that are often located at the edge of the network, closer to the devices generating the data. These nodes can be installed in various settings, including factories, hospitals, and retail outlets. They can be modest devices like Raspberry Pi or more potent servers. Edge computing is becoming a critical technology for allowing the subsequent generation of intelligent apps and services due to the proliferation of IoT and the requirement for real−time data processing and analytics.

What is 5G?

Fifth Generation (5G) is the latest & most progressive mobile communication technology that delivers more rapid data transmission rates, lower latency, & advanced network capacity corresponded to its predecessor, 4G LTE. 5G networks are created on new infrastructure & employ advanced technologies like massive MIMO, beamforming, and millimeter−wave frequency bands to provide faster data rates & more suitable network dependability. With 5G, users can appreciate near−instantaneous download & upload speeds, which is critical for applications like live streaming, online gaming, & virtual reality.

How do Edge Computing and 5G Work Together?

Edge computing & 5G are two technologies that are transforming the way we process & transmit data. Edge computing refers to the processing of data near the source instead of sending it to a central data center. On the other side, 5G, the latest generation of mobile networks, offers enhanced capacity, lower latency, & more immediate download & upload rates.

When combined, edge computing and 5G can build a powerful network that can process & transmit data more efficiently & quickly. By processing data at the network edge, near the devices & sensors that collect it, edge computing decreases the amount of data that requires to be transferred to a central data center. It not only preserves time & lowers latency, but also decreases the load on the network.

Edge devices can communicate with each other and the cloud more rapidly and effectively because of 5G's high speed and low latency.

Edge computing & 5G can allow various novel use cases, including remote healthcare, smart cities, and autonomous vehicles. By lowering lag and improving the overall user experience, they can also improve already−existing apps like video streaming & online gaming.

Benefits of Edge Computing and 5G for IoT

Reduced Latency: One of the most significant benefits of combining edge computing and 5G for IoT is the reduction in latency. Edge computing conveys the computing power closer to the end−user device, which decreases the time it abides to transfer data to the cloud for processing.

Improved Reliability: Edge computing reduces the dependence on cloud servers for data processing, which can be subject to network outages or interruptions. In the event of a network failure, edge computing can continue to process data locally, ensuring uninterrupted operation.

Lower Costs: Edge computing can reduce the costs associated with data transmission and storage. Additionally, edge computing can reduce the need for expensive cloud storage solutions.

Enhanced Security: Edge computing can enhance the security of IoT devices & data by decreasing the data amount that requires to be transmitted over a network. By processing data locally, sensitive data can be kept within a secure network, reducing the risk of data breaches. Additionally, with 5G's improved security features, the transmission of data is more secure.

Increased Scalability: Edge computing can increase the scalability of IoT devices and systems. By processing data locally, edge devices can be added to a system without the need for additional cloud resources. More devices may be added to a network without performance being impacted because of 5G's high bandwidth & low latency.

Better User Experience: Edge computing and 5G can significantly improve the user experience for IoT applications. By decreasing latency & processing data locally, realtime decision−making is possible, leading to faster response times & improved performance.

In conclusion, edge computing & 5G are two fundamental technologies that, when integrated, can transform the way IoT device’s function. By processing data locally at the network edge, edge computing decreases latency, improves reliability, enhances security, decreases costs, improves scalability, & provides a better user experience.

5G's high bandwidth and low latency complement edge computing, resulting in faster and more efficient processing & transmission of data. This powerful combination of edge computing and 5G can enable various novel use cases, including remote healthcare, smart cities, and autonomous vehicles, among others.

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Argument: ‘Smart’ Cities Are Surveilled Cities

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‘Smart’ Cities Are Surveilled Cities

When everyone and everything is connected, the door is open to all kinds of digital threats..

Science and Technology

Cities around the world are getting smarter. A growing number even designated themselves “smart cities.” There are, of course, as many definitions of smart cities as there are cities professing to be smart. Very generally, smart cities deploy a host of information communication technologies—including high-speed communication networks, sensors, and mobile phone apps —to boost mobility and connectivity, supercharge the digital economy, increase energy efficiency, improve the delivery of services, and generally raise the level of their residents’ welfare. Becoming “smart” typically involves harnessing troves of data to optimize city functions—from more efficient use of utilities and other services to reducing traffic congestion and pollution—all with a view to empowering public authorities and residents.

However one defines them, data-enabled cities are booming. By one estimate , there are over a thousand smart city projects underway around the world. Rankings and indices are also proliferating, with such cities as Singapore, Helsinki, Seoul, and Zurich routinely topping the list. Notwithstanding global enthusiasm for hyperconnected cities, this futuristic wired urban world has a dark side. What’s more, the pitfalls may soon outweigh the supposed benefits.

That’s because “smart” is increasingly a euphemism for surveillance. Cities in at least 56 countries worldwide have deployed surveillance technologies powered by automatic data mining, facial recognition, and other forms of artificial intelligence. Urban surveillance is a multibillion-dollar industry , with Chinese and U.S.-based companies such as Axis, Dahua, Hikvision, Huawei, and ZTE leading the charge. Whether they are in China or elsewhere, smart cities are usually described in benign terms with the soothing promise of greener energy solutions, lower-friction mobility, and safer streets. Yet in a growing number of places from New York to Hong Kong , there are growing concerns about the ways in which supercharged surveillance is encroaching on free speech, privacy, and data protection. But the truth is that facial recognition and related technologies are far from the most worrisome feature of smart cities.

Part of what supposedly makes cities smarter is the deployment and integration of surveillance technologies such as sensors and biometric data collection systems. Electronic, infrared, thermal, and lidar sensors form the basis of the smart grid , and they do everything from operating streetlights to optimizing parking and traffic flow to detecting crime. Some cities are adopting these platforms more quickly than others. China, for example, is home to 18 of the top 20 most surveilled cities in the world. Shanghai, which achieved full 5G coverage in its downtown area and 99 percent fiber-optic coverage across the city, is covered by a veritable thicket of video surveillance. Identity collection devices are commonplace, having exploded across public and private spaces. Shanghai recently installed Alibaba’s City Brain public surveillance system, which oversees over 1,100 biometric facial recognition cameras. A combination of satellites, drones, and fixed cameras grab over 20 million images a day. The bus, metro, and credit cards of local residents are also traced in real time. And these tools are spreading. Chinese firms are busily exporting surveillance tech to Latin America , other parts of Asia , and Africa , helping enable what some critics call digital authoritarianism .

A video surveillance camera hangs from the side of a building in San Francisco on May 14, 2019. The city was the first in the United States to ban facial recognition technology by police and city agencies. Justin Sullivan/Getty Images

Surveillance technologies are hardly confined to China. They are also widespread in U.S. cities. Throughout the 1990s and 2000s, law enforcement agencies and private companies deployed surveillance tools, ostensibly to improve public and private safety and security. The 9/11 attacks and subsequent U.S. Patriot Act dramatically accelerated their spread. Yet support for facial recognition systems appears to be ebbing. San Francisco was the country’s first major city to ban its agencies from using them in 2019. San Francisco was among the top five most surveilled cities in the United States when eight of the nine members of its Board of Supervisors endorsed the Stop Secret Surveillance Ordinance . Rolling back surveillance has proved difficult—digital rights advocates recently detected over 2,700 cameras still in use for police surveillance, property security, and transportation monitoring. In 2000, campaigners sued the city for tapping into private cameras to surveil mass protests, in defiance of the new ordinance .

Across North America and Western Europe, the tensions over smart cities can be distilled to concerns over how surveillance technology enables pervasive collection, retention, and misuse of personal data by everything from law enforcement agencies to private companies. Debates frequently center on the extent to which these tools undermine transparency, accountability, and trust. There are also concerns (and mounting evidence ) about how facial recognition technologies are racially biased and inaccurate when it comes to people of color, discriminating particularly against Asian and African Americans. This helps explain why in the two years since San Francisco banned facial recognition technologies, 13 other U.S. cities have followed suit, including Boston; Berkeley and Oakland in California; and Portland, Oregon. By contrast, in China, racial bias seems to be a feature, not a bug— patented , marketed, and baked into national policing standards for facial recognition databases . What’s more, Chinese companies are bringing their technologies to global markets .

But a narrow preoccupation with surveillance technologies, as disconcerting as they are, underestimates the threats on the near horizon. Smart cities are themselves a potential liability—for entirely different reasons. This is because many of them are approaching the precipice of a hyperconnected “internet of everything,” which comes with unprecedented levels of risk tied to billions of unsecured devices. These don’t just include real-time surveillance devices, such as satellites, drones, and closed-circuit cameras. By 2025, there could be over 75 billion connected devices around the world, many of them lacking even the most rudimentary security features. As cities become ever more connected, the risks of digital harm by malign actors grow exponentially. Cities are therefore entirely unprepared for the coming digital revolution.

Baltimore’s information technology office lost dozens of time-sheet records in a 2019 ransomware attack. Kenneth K. Lam/The Baltimore Sun via Reuters

One of the paradoxes of a hyperconnected world is that the smarter a city gets, the more exposed it becomes to a widening array of digital threats. Already, large, medium, and small cities are being targeted for data theft, system breaches, and cyberattacks, all of which can undermine their operation and provision of essential services, and pose an existential threat. Hundreds of cities around the world have reported major digital disruptions to municipal websites, emergency call centers, health systems, and utilities delivering power or water. When city security is compromised and data privacy jeopardized, it undermines the faith of residents in digitally connected services and systems. As people feel more insecure, they may feel less inclined to participate in online health care, digitized utilities, remote learning opportunities, electronic banking services, or green initiatives—key tenets of the smart city. While not all digital threats can be countered, cities need to mount a robust capability to deter, respond to, and recover from attacks while preserving, as best they can, data protection and privacy.

To start, city authorities, companies, and residents need to design digital security into all domains of governance, infrastructure, commerce, and society. At a minimum, new smart city technologies must avoid reinforcing disproportionate surveillance that undermines basic freedoms, especially privacy. National, regional, and city governments should also mandate and enforce standards that require that all internet-enabled devices sold and deployed in their jurisdictions have minimum password protection, authentication, and encryption built in. It is essential that cities encourage digital literacy across the public, private, and civil society sectors, since many potential digital harms can be reduced through basic awareness and precautionary measures.

To get smarter, cities need to know their blind spots. This requires undertaking real-time monitoring to map the vulnerability of wireless devices in their environment. Passive monitoring across broad-spectrum wireless networks to detect data leakages will need to be routine—and properly explained to citizens. Cities will need to invest in automated incident response and in identifying and fixing their vulnerabilities in relation to networks and devices. Above all else, cities will need to take digital risks seriously and enforce security requirements across all connected devices, from the health watch to the ticket scanner to the internet-connected refrigerator, in a smart city ecosystem. The pursuit of smarter cities can and should not come at the expense of safety, privacy, or liberty. Indeed, the failure to prioritize both human well-being and security in a world of exponentially increasing complexity is a monumentally dangerous folly.

huawei-china-spying-britain-xi-jinping-071420

China Will Use Huawei to Spy Because So Would You

There is a long, and secret, history of countries—including Britain and the United States—forcing companies to protect national security by helping them eavesdrop in bulk.

A bidder wears a tie depicting a ringing mobile phone prior to the start of Germany’s auction for the construction of an ultra-fast 5G mobile network in Mainz on March 19, 2019.

China Isn’t the Only Problem With 5G

The network has plenty of other security weaknesses, including ones the United States doesn’t want to fix since they help its own surveillance efforts.

Donald Harrison, Google’s president for global partnerships and corporate development, testifies via live video feed before a Senate Judiciary subcommittee during a hearing on anti-competitive online advertising in Washington on Sept. 15.

Make Surveillance Capitalists Pay Their Dues

Congressional action has typically left big tech firms intact, instead mandating that they improve access for all consumers. Washington should stick to that model.

Robert Muggah is a principal at the SecDev Group, a co-founder of the Igarapé Institute, and the author, with Ian Goldin, of Terra Incognita: 100 Maps to Survive the Next 100 Years . Twitter: @robmuggah

Greg Walton is a fellow at the SecDev Group and a researcher at the Oxford Internet Institute.

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What is the Internet of Things?

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Executive summary

Introduction

Broadband access for communities of color

5G and the capabilities of next-generation mobile broadband

IoT use cases and people of color

A. Health care

B. Education

C. Transportation

5G’s direct impact on employment

Policy recommendations

National Telecommunications and Information Administration

Full Transparency

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5G Use in Healthcare: The Future is Present

Evangelos Georgiou

Richard M. Satava

Background:

Discussion:

INTRODUCTION

Search Strategy and Article Selection

Inclusion- Exclusion Criteria

Article Selection

Data Extraction

1. Communication Basic Principles

Telemedicine

2. Other Critical Supporting Infrastructures

3. Fundamental Biologic Principles

4. Clinical Applications Using 5-G Wireless Networking

Pulmonology

Medical Imaging and 5G

Remote Ultrasonography

Ophthalmology

Interventional Cardiology

Emergency Medicine

1. Pre-operative Preparation

2. Intraoperative Procedure

3. Postoperative Care (Including Outpatients)

Clinical Telesurgery

Telerobotic Spinal Surgery

5. Medical Education and Healthcare Research

5.1. Medical Education

5.2. Healthcare Research

6. 5G and the COVID-19 Pandemic

7. Pitfalls of the Use of 5G in Healthcare

Future Directions

CONCLUSIONS

APPENDIX 1. Other Critical Supporting Infrastructures

THE INTERNET OF THINGS

ARTIFICIAL INTELLIGENCE, MACHINE LEARNING, AND DEEP LEARNING

BIG DATA, QUANTUM COMPUTING, AND COMPUTATIONAL ANALYTICS

VIRTUAL REALITY (VR), AUGMENTED REALITY (AR), MIXED REALITY AND EXTENDED REALITY (XR)

APPENDIX 2: Fundamental Biologic Principles

APPENDIX 3. Use of 5G IN Wuhan China during COVID 19

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