Stephen Morris recalls his father’s battle with Parkinson’s disease.

“He was in a rural county where they have general MDs and a hospice within 10 miles,” Morris said. “But specialists were over two hours away. My family would have appreciated telemedicine. Several times my brother or I had to leave work, drive down, and help Mom take Dad to the closest equipped hospital that was an hour from where they lived.”

Morris is principal of FoothillsNet, a broadband consultant for rural America. He believes telemedicine is incredibly difficult, if not impossible, without broadband. “I envision teleconferences with medical specialists hours away giving advice in real time and adjusting medicines to reduce costly ER visits and hospital stays,” he said.

Telemedicine, until recently, was simple to comprehend. In 2015 Andrew Graley, formerly director of healthcare, government and education for vender Polycom Solutions, defined it as “the remote monitoring of patient health data wherever they might be. Predominantly the patient is in their home, elderly, and suffering from a long-term condition or chronic disease.”

Today, it’s much more than that. Through telemedicine, healthcare providers can use intranet or internet networks to diagnose, administer, initiate, assist, monitor, intervene, or report a medical procedure. And the services can include mental and physical rehabilitation.

Telemedicine touches every medical discipline, including psychiatry. Just about every person from newborns to seniors may have telemedicine influence their lives at some time.

One thing hasn’t changed, however. Broadband may still determine whether rural residents are telemedicine’s “haves” or “have nots.”

When Minutes Matter

Most of us associate ultrasounds with the prenatal procedure that helps moms and their doctors monitor a baby’s development during pregnancy. But ultrasound technology is an ER doctor’s best friend when it comes to diagnosing and treating injuries to muscles, tendons, and many internal organs.

When seconds matter, portable ultrasound devices can deliver images from the scene of an injury, speeding up diagnosis and treatment. But images require bandwidth. The better the broadband connection, the higher the odds of a quicker response.

Some portable ultrasound machines are about the size of a thick, oversized laptop. Emergency responders at a car wreck miles outside of town or a house located in sparely populated areas can feed ultrasound images, readings on heart rate or other vitals, and audio observations to physicians at a rural clinic or a major city hospital. In turn, physicians can more accurately instruct responders how to treat the victims.

“Ultrasounds can determine if there’s internal bleeding, the extent of a fracture, whether a person is just suffering from indigestion or a heart attack,” says Michelle Alexander, clinical marketing director for Point of Care Ultrasound. “But if your connection to the internet is bad, a paramedic can lose valuable time getting to where there’s coverage.” Her company is pilot-testing a product called SonicXpress that is designed to use satellite and existing cellular or WiFi wireless to establish a reliable speed to transmit the data.

Broadband links between medical facilities and emergency responders with portable ultrasound devices can save lives. With more data reaching doctors, patients can get to and through the ER faster, or they can be routed to the correct medical facility to begin with. Communities’ healthcare administrators, emergency preparedness teams, and broadband planning teams should work together to create both the communication infrastructure and telemedicine equipment.

A telemedicine program now links physicians at Baystate Medical Center in Springfield, Massaschusetts, with patients and physicians at more rural community-based Baystate Mary Lane Hospital (25-beds), Baystate Wing Hospital (74-beds) and Baystate Franklin Medical Center (90-beds). Medical areas utilizing telemedicine include critical care for ICU consults, inpatient and outpatient neurology, infectious disease, geriatrics, psychology, and cardiology among others.

Telemedicine for Rural Mental Health

“In the U.S., on average, one in five people have a diagnosable mental illness,” said Dr. Edward Kaftarian, CEO of Orbit Health Telepsychiatry. “In some cases in rural America, that can double. However, the shortage of psychiatrist in rural areas is a tragedy that is unfolding before our eyes.”

Psychiatrists are medical doctors, and they understand if you have an illness in a particular part of the body, this can affect your brain, and similarly the brain and the mind can affect parts of the body as well. Dr. Kaftarian says mental illness, in it’s extreme, can lead to death. “We have 30,000 Americans die every year from opioid addictions. That’s double the homicide rate in the country. We have over 40,000 suicides every year in the U.S., many of those as a result mental illness.”

Dr. Kaftarian strongly believes broadband and telemedicine are a part of the solution to this problem. “There’s no need to delay any broadband projects to rural populations that need it the most, whether the networks are owned by communities, co-ops or whoever,” he said.

Telepsychiatry requires good video and audio connections with guaranteed security, anywhere between 30 and 100 megabits per second. Slower speeds may be adequate, but doctors may lack enough bandwidth for simultaneously charting, accessing medical records, or consulting other information sources.

“If you try to treat patients with lesser quality, you get less effective treatment” said Dr. Kaftarian. “The quality of the experience for both the doctor and the patient is bad, both get frustrated, and they don’t want to continue. If the patient isn’t engaged in the therapy, then they’re not getting better.”

The need for broadband speed isn’t limited to institutions and emergency responders. Medical and community stakeholders who want to leverage broadband have to remember that patients often receive telepsychiatry treatments in their homes. The quality and speed of residential broadband is problematic in many rural areas. Some are still on dial-up Internet connections. “For people that only have dial-up, video is a nonstarter. Even DSL is really pushing it as far as videos is concerned,” Dr. Kaftarian concludes.

Craig Settles is a broadband industry analyst, consultant to local governments, and author of Building the Gigabit City. His latest analyst’s report is “The Co-op’s Broadband Plan for Success.”

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