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Recognition of telehealth’s potential to transform healthcare is one of few silver linings in the Covid-19 dark cloud. Telehealth makes healthcare available at home, and for some, at their workplace.
But the pandemic also ripped open a ragged wound within our healthcare system – the “healthcare gap” – a deadly inequity for rural folks and low-income urban residents. The “healthcare gap” is that very real divide between those who have access to affordable quality healthcare and those who do not.
Telehealth means using intranets and internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care (CoC) – everything that’s done to get you healed.
To narrow the healthcare gap, telehealth services need broadband, but currently, 53% of rural homes lack access to the 25 Mbps download/3 Mbps upload speeds that define broadband.
Luckily a group of senators is lobbying for $2 billion to address telehealth needs, while on the House side, legislators are pushing for $85 billion over the next five years for broadband. Expected money should be available directly and indirectly for telehealth. But do communities have a telehealth strategy?
According to the Centers for Disease Control & Prevention (CDC), “Although persons in rural communities often have worse health outcomes and less access to health care than those in urban communities, rural racial/ethnic minority populations have substantial health, access to care, and lifestyle challenges that can be overlooked when considering aggregated population data.”
A comprehensive strategy with the goal of reducing the healthcare gap could achieve six objectives:
Reimagining Visits to the Doctor
Aggressively deploying broadband will increase access to doctors and specialists at home. But communities need to facilitate telehealth for atypical locations such as schools, libraries, and community centers.
For example, it may be time to double our investment in broadband for schools. “The top two medical issues children face is acute care for things such as earaches, cold, congestion and the like, and those needing specialty care, in particular behavioral health,” says Rena Brewer, CEO of nonprofit vendor Global Partnership for Telehealth. These and other medical services can be delivered via telehealth that augment the school nurse.
Marrying Chronic Care and Home Care
In 2010, 54.3% of deaths from chronic lower respiratory disease (such as COPD) in the most rural counties were potentially preventable, compared with 23.4% in the most urban counties. By 2017, 57.1% of deaths from chronic lower respiratory disease in the most rural counties were potentially preventable, compared with 13% in the most urban counties.
We should Consider giving unserved communities the power to collectively negotiate deals with hospitals, insurers, and employers in which these entities underwrite broadband and telehealth infrastructure that the communities own.
Emergency Response and Trauma Care
Communities are equipping first responder vehicles with mobile wireless hotspots and trauma equipment such as portable CT scanners, ultrasounds, and EKG machines so hospital physicians can deliver treatment even before leaving patients’ homes or scene of an accident.
Local governments should consider strategically deploying high-powered wired and wireless hot spots in case patients need immediate medical attention while still en route to the hospital. Mobile satellite hotspots configured for telehealth could be helicoptered into areas where communities may be isolated following natural disasters.
“There are 65 million Americans that have diagnosable mental health illness but we have less than half of the psychiatric providers needed to meet that demand,” according to Encounter Telehealth CEO Jennifer Amis. “When you look at many of the rural areas, we may have less than 20% of the number of providers needed.”
Carly McCord, Ph.D., is Director of Clinical Services at the Texas A&M Telehealth Counseling Clinic, which partners with seven rural counties in Texas’ Brazos Valley, offering behavioral health services and treatments.
According to McCord, “All of my counselors right now are advanced doctoral students. We are training the next generation of health professionals for work in underserved communities and for work with telehealth.”
Counties could provide different types of physical space – a clinic, a school, a hospital. Patients can meet clinic staff online and/or in person. “I believe that we need both virtual and physical environments,” McCord said. “There’s a whole host of reasons why people need to go to a place to be seen. For some people, they may not be safe where they are staying.”
Senior Healthcare and Aging In Place
More than 60% of low-income seniors are without access to the Internet and 37% of all seniors from all income levels across are without access to computers and internet. Our ability to combat this growing concern is hampered by low connectivity among seniors.
There are three categories of telehealth applications that can help seniors to age in place: 1) general medical services, 2) mental health services, and 3) home health care. High-speed broadband makes these telehealth services possible. Communities might need partnerships with the Internet of Things (IoT) and smart home vendors to help seniors stay in their homes longer.
Re-imagining Hospital Care
As a result of the coronavirus epidemic, Medicare and Medicaid changed their definitions of a hospital. According to a recent press release, “Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration.”
The ruling enables centers to offer services typically provided by hospitals. It also allows non-hospital buildings such as hotels and dormitories to be used for patient care and quarantine.
In this moment of opportunity, communities can explore options of creating “Hospitals of the Future“ by outfitting available buildings with telehealth, broadband, and all the digital health trimmings, while community and state leaders can fight attempts to revert back to the old rules.
More than 100 rural hospitals have closed since 2010 and another 430 are at the brink. Rural closings lead to a 5.9% rise in mortality rates making the issue an actual “life or death” situation.