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Lack of Broadband Access Can Hinder Rural Telehealth Programs

As healthcare organizations implement more telehealth programs to support remote patient care, rural broadband connectivity should be considered for applications.

Source: Thinkstock

By Elizabeth O'Dowd

- Telehealth programs allow patients to connect with their care providers from local clinics or the comfort of their homes. While this is useful to many patients who can’t easily meet with a provider or are interested in saving on travel time, the reliable broadband connections needed to successfully use telehealth services isn’t available to all patients.

The ONC states that access to broadband internet is a requirement for telehealth programs. Adequate broadband is needed to transmit high quality audio and video data as well as text and images. For example, clinicians using video conferencing to treat a patient may need to examine an abrasion or other physical symptom carefully. The broadband connection needs to be strong enough to support high quality video streaming, so the patient can be viewed clearly.

“Telehealth connections are not like the connections needed for traditional business conferences where you can tolerate some poor quality and muddle through it. In healthcare, a poor quality connection is a total deal breaker,” said Morgan Waller, Director of Telemedicine at Children’s Mercy.

Last year, the American Medical Informatics Association (AMIA) recognized the importance of broadband access to modern healthcare. AMIA penned an open letter urging the FCC to categorize broadband access among the social determinants of health due largely to its significance to telehealth.

“Mobile Health (mHealth) technologies that rely on broadband services have a wide adoption variance based on geography, population density, and socioeconomic status,” said the letter. “Vulnerable groups face specific challenges related to inadequate access to affordable and consistent high-speed internet.”

READ MORE: Using Broadband to Support Internet of Medical Things

Remote patients, remote caregivers, or critical access located in areas where there isn’t reliable or affordable broadband service or critical access branches may need access to more resources to provide adequate broadband for telehealth programs.

Broadband includes several high-speed transmission types, according to the FCC. These transmission types include digital subscriber line (DSL), cable modem, fiber, wireless (including Wi-Fi or cellular wireless), satellite, and broadband over powerlines (BPL).

Telehealth applications are most commonly accessed using wireless broadband connections such as Wi-Fi or 3G/4G cellular.

Many telehealth programs are directed toward rural patients who cannot frequently travel to their primary care providers.

The Congressional Research Service concluded that the minimum acceptable level of broadband service is 4 Mbps downstream transmission capacity and 1 Mbps upstream transmission capacity for any government regulated data transmission. While there is no specific set minimum for healthcare broadband speeds, many telehealth programs require a minimum of 1.5 Mbps for both upload and download speeds to successfully display audio and video data.

READ MORE: AHA Stresses Importance of Broadband Access for Telehealth

These speeds are often achievable in urban areas, but health systems that serve large rural areas may not be able to provide telehealth services to rural populations because broadband is not being provided to them in a “reasonable or timely manner.”

The FCC’s 2016 Broadband Progress Report found that broadband speeds were not being deployed to all Americans in a timely fashion. Over 10 percent of Americans (about 34 million) lacked access to speeds of at least 25 Mbps download and 3 Mbps upload. Thirty-nine percent of rural Americans did not have access to these speeds versus 4 percent of Americans living in urban areas.

These speeds are well below the standard needed for many rural patients to participate in telehealth programs. Health systems that serve largely rural areas that would benefit from telehealth programs can be prevented from participating because of the lack of broadband in certain areas.

While most patients can use telehealth applications successfully from branch health system offices and their homes, there are still patients who don’t have consistent access to the broadband they need to transmit information at a high enough quality for telehealth.

Many telehealth tools include broadband-heavy services like video streaming and video conferencing. Without access to broadband, patients will not be able to utilize these tools.

READ MORE: AMIA Stresses Broadband Access is Social Determinant of Health

There is no solution to broadband shortage that will help every organization overcome bad connectivity. However, understanding the kind of broadband access patients and remote care facilities have outside the main health system can help IT executives take steps to provide networking resources for those without adequate signals for telehealth programs.   

Making efforts to develop telehealth applications and software services with less bandwidth requirements can also help improve connectivity.

Mobile applications are often developed to provide clinicians and patients with mobile tools that access multiple data sources for increased workflow or to give patients an easy way to access their personal health data. They are used extensively in telehealth programs.

Many of these apps are web based and accessed using a standard 4G LTE or a Wi-Fi broadband connection. However, web-based healthcare apps are notorious bandwidth hogs, which can cause slow speeds for the clinicians and patients using them.

Building native apps can reduce the app’s bandwidth requirements, and apps with offline capabilities can use application caching to save a cached version of the app interface if the patient or clinician is experiencing a weak or spotty connection.

Forming strong vendor partnerships with broadband service providers and medical device manufacturers will help organizations better connect their rural telehealth patients.

Asking vendors their typical uptime and bandwidth is important, as well as asking network vendors how fast they can bring up a new remote site or VPN. How much experience do they have providing new network connections? Can they keep connections up and running? The answers to these questions will determine if a vendor will be consistently useful.

While perfect broadband connectivity is still out of reach, especially for patients in rural areas, taking steps to reduce application bandwidth and working with vendors to understand their coverage capabilities are key steps to building a connected telehealth infrastructure.

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