My colleague Craig settles down likes to say he had a “stroke of genius” writing his latest book on building the gigabit city. “I literally had an ischemic stroke at 10:30 p.m. on a Saturday night,” he recalls. “If I had been in a low-income urban community with poor communications infrastructure, or in a rural area with poor broadband, I would probably be dead.”
The “genius” part was realizing that broadband is magic that directly or indirectly allows us to perform minor and major miracles that we couldn’t do before, but faster and easier.
When Craig moved to Alameda, Calif., located less than five miles from the heart of Silicon Valley, he couldn’t get cell service without a signal booster, and even then it was sketchy. Several years later, the service improved, allowing him to quickly call his best friend who dialed 9-1-1.
The neurologist who set up the stroke center at Alameda Hospital had replicated much of her technology and servers in her home so she could see everything the ER staff were seeing while he was administering life-saving procedures within 25 minutes of Craig’s stretcher hitting the ER door.
As Craig counts his blessings, more than 14 million urban households don’t have broadband in their homes — 75% of whom are African Americans and other people of color. Millions more technically have home internet service, but lack the connection speeds and ability to use the apps needed for remote work and school, or telehealth.
And don’t forget the 4 million rural households that don’t have a broadband subscription.
Broadband as a social determinant of health
The essential nature of broadband came to the fore with the onset of the pandemic. And it has forced states and local communities across the country to take the connectivity crisis much more seriously, especially with the influx of federal funds from the American Rescue Plan Act and Infrastructure Investment and Jobs Act.
While advocates commonly and rightly tout the importance of broadband access in the context of remote work and schooling, what is often overlooked are the transformative powers of telehealth and its potential to encourage the adoption of broadband.
It’s no exaggeration to say that broadband is a major social determinant of individual health, as it enables access to virtual healthcare and facilitates a host of other health essentials, such as education, employment, housing and social services, all of which require broadband. , especially for telehealth applications.
More than video chats with your doctor, telehealth uses high-speed internet connectivity to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record and/or report across the continuum of care. Public health, in particular, can greatly benefit from telehealth.
Yes, health care providers are increasingly integrating telehealth into the delivery of care. But, if the patients who most need better access to healthcare lack access to broadband, along with computing devices and digital skills, huge healthcare benefits and cost savings will be unnecessarily missed.
This suggests that “fiscally conservative” elected officials, many of whom claim to support universal broadband access while lamenting the high cost of health care, have thought it all backwards. Instead of lamenting the cost of building a robust, universal broadband infrastructure that could be used for telehealth, why not turn the script around?
Building a universal broadband infrastructure that would last a lifetime would cost on the order of $100 billion, or just 2.5% of what we spend on health care in this country. every year. Hundreds of academic and industry studies indicate that even the most conservative telehealth initiatives save more than 2.5% of system costs.
Talk about a return on investment! A clue to this can be seen in a study by the National Center for Biotechnology Information which found that there were as many as 3.5 million preventable adult hospital stays among adults in 2017 alone. $33.7 billion in health care costs this year alone.
Telehealth can eliminate many of these stays. And in terms of improved health outcomes, the study further found that seniors, men, black communities, and Medicaid recipients would experience the greatest benefits.
So why not leverage the math and pay for broadband using healthcare savings? Let’s connect every home, hospital and community anchor institution in the country to robust broadband and transform healthcare while bringing it into the 21st century. The municipal broadband model in which local communities build and own the infrastructure is ideal.
Telehealth can drive broadband adoption
Seen in this light, universal access to telehealth has the potential to simultaneously solve the connectivity crisis and ensure that millions of families can lead healthier lives.
Here are six tactical ways to use telehealth to maximize public health in a community while increasing broadband adoption.
- Reinventing the Doctor Visit for a Variety of Healthcare Practices
To understand telehealth, all you need are four walls, an internet connection, a computer, a healthcare partner and a healthy imagination to create a range of practical telehealth solutions.
Turn hair salons and barbershops into Covid vaccination and hypertension screening centers. The school infirmary can now become school telehealth centres. Libraries are beginning to add telehealth kiosks.
Libraries Without Borders uses interactive health web content, laptops and wireless equipment to equip intercity laundromats on Saturdays. Tucson used ARPA funds to build a wireless network above the city’s fiber optic infrastructure and gave 5,000 low-income homes the option of telehealth resources.
- Telehealth can combine chronic care, home care and public health
Frederick Memorial now distributes hundreds of tablet computers for remote patient monitoring in patients’ homes to check their vital signs, progress of medical conditions and treatments, with data that is transmitted daily to the hospital.
Urban hospitals should partner with ISPs to take advantage of the FCC’s Affordable Connectivity Program subsidy of up to $30/month for internet service and up to $75/month for households on tribal lands. ACP is also offering a $100 discount on computer devices.
- Improving emergency response and the emergency department to save more lives and money.
African Americans and other populations of color have the highest rates of strokes, heart attacks, and other medical trauma. We could reverse the trend of hospitals abandoning poor urban communities and replacing them with “broadband sub-networks” of telestroke or telehealth intensive care that are hosted by large hospitals and linked to health centers. federally licensed clinics and other facilities.
- Increasing the efficiency of mental health care delivery
Mental health professionals who see patients in their homes and therefore provide an alternative to the need to travel to a therapist’s office can not only eliminate missed appointments, but can also offer those most in need therapy greater access to a variety of specialists.
Leveraging telehealth can be especially empowering for underserved communities where about 30% of African American adults with mental illness receive treatment each year, compared to a US average of 43%, according to the National Alliance on Mental Illness.
But like Carly McCord, director of clinical services at the Texas A&M Telehealth Counseling Clinic, rightly points out, “We often talk about intensive therapy, like treating PTSD, which you can’t do with shitty internet connections. When your patient reveals trauma and your connection breaks, or you miss a word and have to say, “I’m sorry. Can you repeat that? ‘This is a huge problem.’
- Improving elder care and making aging in place easier for our nearly 60 million seniors
According to an AARP survey, three out of four older Americans want to stay at home and age in place. And, given the choice, about 53% of respondents say they would prefer to have their health care needs handled by a combination of medical personnel and health technology.
A key component of broadband in this telehealth equation is “smart home” technologies that include wirelessly controlled sensors. Some sensors can now determine whether a person has sat up in bed or fallen on the floor, whether patients are eating regularly or taking their medication on time.
- Reinventing what hospital care can be
In areas prone to natural disasters, make prior arrangements with hotels, college dorms, warehouses, and other facilities where you can bring generators, computers, telehealth equipment, and wireless intranets.
Use these buildings for older people with medical conditions who have been displaced: people with chronic illnesses and patients with minor injuries from the disaster, if these people do not have easy access to other facilities residential or health care.
Building and subsidizing access to robust community-owned broadband networks is a wise investment because it will improve health outcomes and generate significant savings for the community for decades to come.
And with a plethora of federal funds available to build broadband infrastructure and advance digital equity, we have a unique opportunity to bring it all together and bring telehealth to everyone.
Sean Gonsalves is a senior reporter, editor and communications team leader for the Institute for Local Self Reliance’s Broadband Community Networks Initiative. Saved from a stroke by telehealth, Craig Settles is paying off by uniting community broadband teams and healthcare stakeholders through telehealth-broadband integration initiatives. This room is exclusive to Broadband Breakfast.
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