Telehealth and community broadband, in sickness and in health

Telehealth and community broadband are symbiotic technologies.

Much more than mere video chats, telehealth uses intranets and the internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care people receive when ill, injured or wanting to stay well. We can save so much money and time that’s going into healthcare if we take full advantage of the telehealth and telemedicine tools. Public health, in particular, can leverage telehealth to great advantage.

Community broadband, meanwhile, refers to networks owned by towns, cities and counties, local telephone and electrical co-ops, wireless internet service providers (WISPs) and other local ISPs, and public-private partnerships often initiated by municipalities or counties.

But big companies often have high prices, suboptimal service and weak infrastructure, so communities nationwide are building their own. These networks profit the people they serve.

Telehealth united with community broadband has huge financial and quality-of-life benefits. These technologies also open avenues to digital equity and health equity among underserved communities in towns, cities and counties.

Don’t forget, though, that it’s quite difficult to have telehealth without broadband.

Strategically speaking  

Let’s break down telehealth into three categories and consider as an example public libraries that decide to offer telehealth in some of their branches.

Real-time telehealth refers to activities happening “right here and now,” often involving medical or healthcare professionals. Maybe the larger library branches can designate reading rooms or purchase telehealth kiosks so that patrons can schedule a time or drop in to have private, secure telehealth sessions with their doctor in real time.

Store-and-forward telehealth is collecting medical data, digital images, etc., and sending it electronically to another site for later evaluation. Let’s say a telehealth company can schedule a time to come to your house for lab work that they collect and take to the lab on Tuesday. On Thursday, you go to a library telehealth kiosk for the doctor appointment because the doctor wants to review large files from the lab work with you and your home internet connection is too slow.

“Passive” telehealth refers to storing and accessing digital knowledge bases, health and wellness Web content, and interactive software applications that help us understand, prevent, treat or recover from threats to our physical and mental health. After your telehealth appointment, you ask the librarian for help sorting through their medical video clips related to your diagnosis.

Libraries and their healthcare partners need to ensure that they have adequate bandwidth for multiple audio and video streams. That requires enterprise-level internet access, not a consumer-grade bandwidth. Whether wireless or fiber, the bandwidth needs to be synchronous, meaning equal download and upload speeds, and have enough capacity to facilitate multiple video streams.

A framework for tactical action

Here are six tactical ways of using telehealth to leverage or maximize public health in a community along with attendant uses of broadband.

1. Reinventing the doctor office visit for a variety of healthcare practices, including observation, screening, gathering data, data exchange and medical counseling

Those in public health and other areas of healthcare should take the position that wherever there is seriously fast broadband and at least 10 feet x 10 feet of available space, that’s a potential spot for developing a patient/doctor relationship. For example, take a barbershop or hair salon, a laptop, decent broadband, a healthcare partner and money – and there is a potential telehealth site.

2. Marrying telehealth chronic healthcare and home care so the constant appointments and treatments can be made less intrusive at home, or possibly an office at work

In July, the White House recruited 1,000 barbershops and hair salons to be COVID vaccination centers. Consider designating some of those as Telehealth Ground Zero by 1) funding a buildout of fixed-wireless broadband on the tops of several nearby structures, and 2) distributing wireless routers to homes in the immediate area. Have a community WISP sell and support a permanent broadband solution, and hire the shops and salon to introduce customers to telehealth. Perhaps departments of health can oversee chronic healthcare.

3. Enhancing emergency response to save more lives

Build out stand-alone high-powered Internet stations along rural routes to hospitals that emergency vehicles can connect to in case patients’ conditions deteriorate, or designate schools, libraries and other buildings as telehealth way stations for vehicles. Use these stations in natural disasters when people could be isolated from any medical help for days or weeks.

4. Expanding efficiency of mental healthcare delivery

About 20,000 people per 100,000 experience some mental illness, but there are just 268 mental health providers for every 100,000 people in the U.S., according to the United Health Foundation. Telehealth can increase providers’ efficiency and reduce downtime. Carly McCord, director of clinical services at the Texas A&M Telehealth Counseling Clinic, explained: “We’re talking about intensive therapy, like treating PTSD, which you can’t do with crappy internet connections. When your patient’s disclosing a trauma and your connection glitches, or you miss a word and have to say, ‘I’m sorry. Can you repeat that?’, this is a huge problem.”

5. Improving senior care and facilitating aging in place

Several aspects of telehealth are targeted for seniors, but the main objective is to ensure seniors continue to receive healthcare and live safely in their homes for longer. A key broadband element of this telehealth equation is smart home technologies that include wirelessly controlled sensors. Some sensors now can determine whether a person sat up in bed or fell on the floor, they are eating regularly, and they are taking their medications on time.

6. Reimagining what hospital care can be, one of the few good things learned from the pandemic

Think differently about hospitals. “Converting dormitory facilities to handle remote monitoring of patients recovering from surgical procedures is one of the easiest to set up and has the least amount of costs,” said Peter Caplan, managing consultant for New York-based eHealth Systems & Solutions.

Chicago Mayor Lori Lightfoot last year repurposed 2,000 rooms at five hotels to house asymptomatic people requiring isolation due to COVID-19 to ease the burden on hospitals and financially bolster hotels whose occupancies have taken a major hit.

After the dream comes work

These telehealth strategies and tactics can provide some structured thought as to how to deploy telehealth and broadband together. But as they say, the devil is in the details. There’s a lot of legwork and community needs analysis required, as well as much community stakeholder planning to make these visions a reality. Is your community prepared so you get the job done?

Earlier this month I was a guest expert on “Ask Me Anything!” where I answered questions about stronger broadband and telehealth proposals for federal grants. Read the archive of the Q&A here.

Saved from a stroke by telehealth, Craig Settles pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth-broadband integration initiatives. Follow him on Twitter @cjsettles101.

Dr.Jobs