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Broadband: The Missing Link to Rural Telehealth Success

Health systems from Maine to Minnesota need reliable broadband to extend their telehealth networks to rural residents. But will the feds make the connection?

By Eric Wicklund

- A small Minnesota hospital using remote monitoring technology to serve the state’s four poorest counties is hitting a familiar roadblock: Lack of broadband.

The Lakewood Health System Hospital in Staples covers some of the most rural parts of the state, and is using a telemonitoring platform to connect with residents with heart disease, high blood pressure and respiratory issues. The platform reminds those patients to keep track of their vital signs, which are also sent to the hospital for clinical evaluation.

But many of these communities lack high-speed Internet access. And if the connection to the hospital isn’t reliable, neither is the data.

"We do some on cellular, but it's not very good," Bonnie Johnson, the hospital’s director of home-based services, told Minnesota Congressman Collin Peterson during a recent visit.

According to the Grand Forks Herald, Peterson visited the hospital after officials there travelled to Washington D.C. to seek funding and legislative support for an expansion of the hospital’s telemedicine services. The hospital has a telestroke platform up and running in conjunction with St. Cloud-based CentraCare, and would like to expand into cardiac care, behavioral health and dermatology.

READ MORE: Broadband Problems Derail Montana's Telemedicine Legislation

"It'd be great with our mental health patients, call a psychiatrist and let them do their face-to-face on a monitor," Connie Wells, the hospital’s emergency services manager, told Peterson. "That's one where in the ER, we are really pushing for it, because we have a lot of mental health patients that are having to stay in the ER longer and longer."

Peterson’s response: You need better broadband.

"That's what we need to do in all of these rural counties," he said. "You could save people a lot of time and get them better healthcare by having telemedicine and so forth, but you need broadband."

In rural locations from Minnesota to Maine to Alaska, broadband issues are hindering efforts to expand telemedicine to those who need it the most. An estimated 7 percent of the nation’s healthcare providers serving rural areas lack broadband access, and those who do can pay as much as three times what urban health systems pay. The issue has even been recognized by the Centers for Medicare & Medicaid Services, which is granting EHR Incentive Program waivers to some health systems that don’t have the Internet access to meet meaningful use objectives.

In August 2015, Maine Senator Angus King, who had served as the state’s governor, held a round-table discussion with close to 50 healthcare providers on the challenges of providing telehealth services in a decidedly rural state. Officials there said only about a quarter of the state has adequate broadband coverage.

READ MORE: Broadband Offers a Telehealth Lifeline to Rural Hospitals

Those around the table agreed that telehealth services could be extended – to seniors living in remote parts of northern Maine, fishermen living on islands off the coast and so many others – just by using what technology they have at hand, be it a smartphone or a laptop or whatever they could get at the local store. But they need to make sure the connections are good.

"The technology is there, in many ways, although the big gap is in broadband, which is something we spent a lot of time talking about," he told the Maine Public Broadcasting Network. "It really doesn't work unless you have pretty good broadband connections and the very people we're trying to help the most are those that are in rural areas where broadband coverage is spotty."

Last December, a coalition of healthcare organizations and telehealth advocates petitioned the Federal Communications Commission to revise the Rural Healthcare Program and its Healthcare Connect Fund to, among other things, increase incentives to help rural healthcare providers access affordable broadband necessary to support telehealth, support more remote patient monitoring efforts and help launch coalitions that enable safety-net healthcare providers to “participate in the unfolding broadband revolution.

“The need amongst many rural healthcare providers for access to high quality broadband access is profound,” wrote Thomas Leary, vice president of government relations for the Healthcare Information and Management Systems Society, and Personal Connected Health Alliance Vice President Robert Havasy in a two-page letter of support. “This need for wireless and wireline broadband access represents a critical component to furthering a nationwide network optimized for tomorrow’s high-quality healthcare delivery systems. Benefits of expanded broadband access include the ability to conduct secure high quality eVisits such as telemedicine and expanded remote patient monitoring within the home.”

Last month, the FCC announced changes to its $2 billion Connect America Fund to increase broadband access for rural schools, libraries and healthcare providers. Chairman Tom Wheeler said the changes put the agency at “third base” in efforts to ensure “that consumers in rural and high-cost areas of the country have access to advanced telecommunications and information services that are reasonably comparable to those services in urban areas, at reasonably comparable rates.”

READ MORE: GAO Report: Telehealth Troubles Tied to Reimbursement Barriers

In the meantime, Lakewood officials are looking for the support they need to provide telehealth services to their rural residents.

"Our goal is to be able to keep patients in their hometowns," Wells told the visiting Congressman. "It helps with the healing to be able to stay in their home environment."

Dig Deeper:

FCC Petition: Better Rural Broadband Means More Telehealth Services

Project ECHO Poised to Become a National Telehealth Model




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