Northern California health care organization struggles with telecom infrastructure deficiencies

Deficient Internet telecom infrastructure is hamstringing a rapidly growing non-profit health care organization that administers Medicaid benefits for more than 500,000 beneficiaries in 14 Northern California counties including Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Shasta, Siskiyou, Solano, Sonoma, Trinity and Yolo.

“The biggest challenge we’re facing is (inadequate) broadband Internet,” in the region, Elizabeth Gibboney, CEO of the Partnership HealthPlan of California, told a health care symposium sponsored by the California HealthCare Foundation in Sacramento this week. In particular, Gibboney cited her organization’s need for modern connectivity to support safety net clinic sites and telehealth consultations with specialists as well as teleworking staff.

Telemedicine: Benefitting Providers & Patients | USTelecom

Telemedicine: Benefitting Providers & Patients | USTelecom

A number of presenters at this week's California Telehealth Network 2015 Summit #TELEHEALTH2015 mentioned deficient telecommunications infrastructure and services as a key impediment to greater adoption of telehealth, particularly in rural areas where it can offer the greatest benefit to patients and providers.

As health care goes online, Internet infrastructure takes on greater importance

Internet Backup Options Can Be Pricey, Complicated - Data Centers on Top Tech News: Disruptions to Internet service can and do happen for many reasons, ranging from hacker attacks to solar storms. With online access vital for so many services today, such interruptions can be far from merely inconvenient.

Last month's vandalism in Arizona, for example, raised "major implications for telehealth in northern Arizona," according to the Arizona Telecommunications & Information Council. That's a concern for many rural and tribal communities for whom phone and Internet services can be the primary means of accessing health care.

Deficient telecommunications infrastructure limits growth of telehealth

Just What the Doctor Ordered: Telehealth Poised for Growth: “Rural healthcare providers (HCP) continue to suffer from limited access to broadband speeds necessary to fulfill their rapidly expanding public and private Internet network needs vital for telehealth communications with patients and HCPs,” said Tim Koxlien, founder and CEO of Rural Health Telecom. “Upgrading rural health care provider broadband networks will dramatically enhance their ability to implement new telemedicine technologies and increase access to electronic medical records. This will ultimately enable them to better serve patients through streamlined operational efficiencies, expanded patient service access, reduced costs and improved quality of care.”

Koxlien also noted that high equipment installation costs and a workforce deficit of trained IT personnel as two challenges facing telecom accessibility. “Many local service providers are reluctant or unwilling to expand into these underserved markets because of the costs associated with designing and implementing rural networks, [and a] lack of funding,” Koxlien said.

Telehealth provider complains many consumers lack bandwidth to meet newly adopted telehealth guidelines

Model policy designed to guide state medical boards in regulating the delivery of medical services remotely via telemedicine (also referred to as telehealth) has drawn protest over its requirement that doctors and patients cannot rely exclusively on lower bandwidth applications such as texting, email and voice communications and instead must utilize higher bandwidth secure Internet videoconferencing.

“Not everybody has a video device or has access to the bandwidth” to make the standard useful, said Henry DePhillips, chief medical officer of Teladoc in remarks reported by Modern Healthcare. Even for consumers in an urban setting, “over 95 percent of the time, will chose the telephone, even if they have the device and the bandwidth,"DePhillips added.  

The Federation of State Medical Boards Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine defines telemedicine as follows:

“Telemedicine” means the practice of medicine using electronic communications, information technology or other means between a licensee in one location, and a patient in another location with or without an intervening healthcare provider. Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation, or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional, encounter in person between a provider and a patient. 

The bandwidth adequacy concern raised by DePhillips has merit insofar as a sizable segment of American homes are located in areas that lack telecommunications infrastructure able to reliably support videoconferencing, while the pricing models of mobile wireless providers are designed to discourage the use of high bandwidth applications.

New Telehealth Program Aims To Increase Specialist Care in Northern California - California Healthline

New Telehealth Program Aims To Increase Specialist Care in Northern California - California Healthline
Adequate Internet infrastructure providing sufficient bandwidth is identified as a major challenge to the implementation of the program, which would alleviate the need for patients in rural areas to travel long distances to visit healthcare providers.

California should invest in modern telecommunications infrastructure, not high speed rail

Stanford University public policy professor Joe Nation makes an excellent point in this article on transportation infrastructure. Nation, a former California state legislator, notes high-speed trains work in densely populated areas (like the Boston-New York-Washington corridor, for example) and not states like California with large rural, quasi-rural and exurban areas.

In the evolving digital, information-based socio-economy (much of it innovated in Silicon Valley), the Golden State would likely be better off  investing in fiber to the premise telecommunications infrastructure. Particularly since market forces don't tend to produce meaningful private investment in premise telecommunications infrastructure in less densely populated areas that are in danger of becoming neglected backwaters left off the Internet. Putting this infrastructure in place would also enable these areas to more fully participate in the digital economy, reduce the need for commutes to metro areas and benefit from services such as telehealth and distance learning.

High speed rail might have been a suitable project had it been proposed three or four decades ago. What's needed today is ubiquitous, high speed Internet.

It's no longer 1996: Outdated perceptions of the Internet persist

There remains a major misapprehension in the United States -- in the nation that invented it -- that the Internet is only about email and websites when in fact it delivers Internet Protocol TV and movies. It's also the updated version of Plain Old Telephone Service (POTS) over copper to Voice Over Internet Protocol (VOIP). And that's not even mentioning videoconferencing, telehealth and distance learning. All can be delivered simultaneously over a single fiber optic connection.

Nevertheless, there remain many media accounts such as this one from Minnesota Public Radio that would have readers believe it's still circa 1996 when the Internet was a relative novelty (then mostly accessed via AOL over dialup connections). A decade and a half ago, it was understandable that as this January 17, 2012 MPR story reports there were "Many people don't believe there's anything on the Internet they need." That was a relevant perception back then. But it's badly outdated in 2012.

Telehealth Market To Hit $6.28 Billion By 2020

The global telehealth market is headed for explosive growth over the next decade, according to a new report from InMedica, a division of IMS Research. The main reasons are increasing disease prevalence, an aging population, and governmental pressure to hold down healthcare costs.

"Many public healthcare systems now have targets to reduce both the number of hospital visits and the length of stay in hospital," said Diane Wilkinson, research manager at InMedica, in a press release. "This has led to a growing trend for healthcare to be managed outside the traditional hospital environment, and as a result, there is a growing trend for patients to be monitored in their home environment using telehealth technologies once their treatment is complete.

It's not only the aging population but also its massive numbers as the Baby Boom generation enters maturity. As one of the sources quoted in this article points out, there aren't enough doctors and institutions to care for them nor sufficient funds to pay for that care. Home-based care however will require an extensive revamp of our outdated and incomplete telecommunications infrastructure so that every home is served by big fiber optic pipe with the capacity to carry large amounts of data necessary to support remote diagnosis and monitoring.