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Libraries are in the vanguard of transforming healthcare delivery. Libraries reach out and touch virtually everyone in their communities across the entire economic spectrum. The same way libraries brought high-speed Internet to the underserved communities, so they will deploy telehealth to bring affordable healthcare where it’s most needed..

In October 2020, the Daily Yonder spotlighted Pottsboro, Texas’ public library and its director, Dianne Connery, who had plans to open a telehealth center in the library. Connerly seems to have unleashed significant pent-up desire to replicate telehealth in libraries nationwide. 

She rolled out her telehealth center in January 2021 and in February she was promoted to rural special projects librarian. “Manage your expectations because it takes a while to build the crowd to telehealth services,” she said. “We only set appointments for two days a week. Our partner, the University of North Texas Health Science Center, will keep our growth steady and controlled.”           

A lot of libraries right now are struggling to keep up with everything that’s going on,” said Henry Stokes, library technology consultant at Texas State Library and Archives. “But as they move forward and see their peers push telehealth initiatives, we’ll see health become prominently featured in libraries. Telehealth is such a great fit!” The Federal Communications Commission’s $7.1 billion E-rate grant program for libraries and schools will move many libraries sooner rather than later.

Move Quickly But Be Smart

Telehealth became suddenly popular in the first couple of weeks of the pandemic as both doctors and patients wanted to avoid in-person visits. Although  libraries might have been closed, they kept busy.

“In 2020, many courts required virtual online attendance,” said Lucinda Nord, executive director for the Indiana Library Federation. “Librarians learned effective virtual meeting skills that will help us expedite telehealth work.”

These projects had librarians setting up spaces with high quality video and audio connections that may be used for telehealth appointments. There also were transition costs for training technology, buying sound baffling, and developing new skills. Libraries had to be creative on the fly to ensure patrons’ privacy, as well as the sanitation of equipment and space. 

As several small rural communities in Texas and elsewhere consider telehealth, clinicians are realizing that they short-change themselves in thinking of libraries only as spaces where you store equipment. 

Library staff can play an important role supporting the health information needs of their community. There are medical databases they can learn how to use. They can be trained to act in an adjunct capacity.   

That brings us to what it is, exactly, that libraries could be doing if they move into telehealth.

What Happens When Your Library Goes “All In” for Telehealth?

The official definition states that: Telehealth uses intranets and 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. 

I’ll take it one step further and differentiate between: 1) real-time telehealth, 2) store-and-forward telehealth, and 3) “passive” telehealth.

Real-time telehealth are activities happening “right here and now,” and often involve medical or healthcare professionals. In a library setting, a patron would be video chatting with a doctor from a study room or other enclosed private space. A traveling nurse could set up in a room to do hypertension screening with patrons and video conference with a doctor in another location should patrons have questions. 

Store-and-forward telehealth is collecting medical data and sending it electronically to another site for later evaluation. Patrons who don’t want to go over their data limit) might use library’s Wi-Fi to send medical records, test results or digital images. For maximum privacy and security, telehealth applications receive and send data using HIPAA-compliant software.    

“Passive” telehealth refers to educational web content, digital knowledge bases, and software applications that help us understand, prevent, treat, or recover from threats to our physical and mental health. Few entities are as competent as libraries for making knowledge easy to find and sort through.       

Can Telehealth Surpass the Challenges It Faces?

There are plenty of rewards and challenges facing telehealth success in rural areas. Often these challenges are nothing that money can’t cure. But will the Federal Government’s plan to lay out billions of dollars be enough?    

Of the $7.1 billion proposed by the FCC, E-rate program targeting libraries and schools (plus the $200 million from the Institute of Museums & Library Services’), a lot will go to libraries to boost infrastructure in their facilities. But also, much will be spent for mobile hotspots and laptops that give library patrons a way to have telehealth and other apps at home.

“On the one hand, mobile hotspots are an incredible stopgap solution while we wait to build out broadband infrastructure,” said Lucinda Nord, Executive Director of the Indiana Library Federation. “On the other hand, mobile hotspots are limited in quantity and reach, and should be considered only a stopgap solution.”  

While the bulk of American residents use 4G wireless networks and devices such as smartphones, many rural residents, the elderly and the disabled use nearly out-of-date 3G networks and devices such as flip phones. The giant cellular companies are abandoning 3G networks, and manufactures are abandoning flip phones as well as hearing aids and other consumer electronics. Telehealth vendors are hard pressed to support these older technologies as well.

The lack of digital literacy is a barrier to rural broadband adoption.  Library employees are the digital navigators who assess Internet users’ access to technology and baseline digital skills, and advise how to get free or affordable solutions to meet their needs. 

Shauna Edson, Digital Inclusion Coordinator for the Salt Lake City Public Library, with a grant from IMLS and in partnership with  the NDIA, has built a digital navigator operations model for organizations and libraries to use nationwide.

Telehealth is being touted as a great potential equalizer in the battle for healthcare equity. Broadband and libraries are two main vehicles enabling communities to deliver that telehealth.     

Craig Settles, saved from a stroke by telehealth, pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth initiatives. Read more about Pottsboro and other libraries’ telehealth efforts.

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