Continued Rural Telehealth Growth Expected for 2020

"We've been talking about various forms of telehealth for about 30 years," said Alan Morgan, CEO of the National Rural Health Association, but it has really taken off in the past three to five years. "There's no reason to think we won't see it accelerate in 2020."

"Telehealth has transformed the broadband needs of healthcare facilities," emailed Todd Foje, CEO of Great Plains Communications. Telehealth helps connect rural providers to urban counterparts "through remote diagnosis, video conferencing, electronic health record transfer" and more, all "dependent upon a scalable and reliable Internet connection."

"You don't want latency issues in a crisis situation," said Chad Rupe, Rural Utilities Service administrator. He said RUS' ReConnect broadband grants program gives priority to applicants that provide 100 Mbps symmetrical. Some technologies, such as robotic surgery and telestroke diagnosis, may require more data upload capacity.

Getting broadband deployed to the home is important, Rupe said. In rural areas, remote patient monitoring technology could let people stay on their farms or ranches longer before needing a nursing home or long-term care facility.

Working Together

Public-private partnerships help spur adoption.

C Spire works with the University of Mississippi Medical Center for Telehealth (see 1910230062). The partnership offers a mobile app to schedule online video chats between patients and physicians. The affiliation agreement splits revenue between healthcare providers and the technology provider, "which is us," said Jack Bobo, C Spire telehealth manager. He called the Mississippi Delta "the poorest region in the poorest state," with the fewest number of doctors per capita.

C Spire hopes to introduce its second mobile healthcare app this quarter to help monitor chronic patients. Bobo said the app might monitor weight, blood pressure and oxygen levels in some patients to help alert remote nurses to changes that could send a patient to the emergency room if left untreated. The telecom provider would ship patients Bluetooth-enabled medical devices specific to their chronic conditions, perhaps a glucometer, a pulse oximeter and a scale, he said. Recent changes to Medicare for remote patient monitoring will likely reduce or in some cases eliminate patient cost, he added.

Successful telehealth requires a patient, doctor, medical device company and ISP, said Josh Seidemann, NTCA vice president-policy. "They all have to work together." Not all telehealth applications require the same level of broadband performance or bandwidth, he suggested. Taking a blood pressure reading through a connected device and transmitting it instantly to a remote nurse isn't a high-capacity event, he said. "Once you get into streaming video and two-way dialogue, a high-quality connection is important."

Telehealth "is breaking down the walls of the hospital," said Jonathan Linkous, CEO of the Partnership for Artificial Intelligence, Telemedicine & Robotics in Healthcare (PATH). Applications in the home might not require symmetrical speeds, he said, because "you're not sending an MRI or doing robotic surgery, at least not today." In the home, he said, "it's good enough if there's good quality video" to support a practitioner's ability to see a patient's skin tone, for example. He said a face-to-face connection might be reassuring in teletherapy.

Telecom providers should consider telehealth as part of their business model, said NostaLab President John Nosta. He said many telecom providers recognize the potential in healthcare but shy away because of the industry's complexities. He recommends they partner with others to provide care. He said it's not just patients and hospitals that require connectivity but, increasingly, ambulances. "4G and 5G allows the first responder to become the extension of the clinical diagnosis," Nosta said.

Better Technology

Video and faster speeds also aid telehealth.

"Video transmission will be a big breakthrough" for telehealth, said attorney Cherie Kiser of Cahill Gordon. She cited a partnership between a school nurse's office in rural Kentucky and pediatricians at Vanderbilt University Hospital in Nashville. "Parents, if they have an app on their phone, can remotely monitor the visit," she said. "That's the kind of thing that improves patient outcomes."

A big driver of increased demand for telehealth-level broadband connectivity among healthcare providers is the exchange of electronic medical records, said Schools, Health & Libraries Broadband Coalition Executive Director John Windhausen. "Doctors are going online to check medical records and sending MRIs and other diagnostics to urban doctors to review." If transmission of healthcare data or electronic medical records breaks down, he said, "the doctor cannot provide care."

Telehealth isn't a silver bullet but has become more accepted by patients and physicians in recent years, said Judson Hill, former Georgia Republican state senator who has represented telecom interests. It's not a solely a telecom carrier's responsibility to bring broadband to rural areas that don't have sufficient population to support profitability, he said. Nor is it government's role to solve the challenge of deploying rural broadband to support telemedicine, but government can create a regulatory environment that helps it flourish, he said. He noted some states have lowered the barriers to telemedicine, and he would like to see a consolidated policy from federal and state governments.

"We're in the middle of a major transformation in the way we do healthcare," said PATH's Linkous. He said some telecom providers see the market opportunities "and they want a piece of it." He recommends partnerships: "It's a huge opportunity, but don't do it solo."