Curtis Lowery, M.D., chairman of the University of Arkansas for Medical Sciences Department of Obstetrics and Gynecology, consults with a couple about their baby's ultrasound via a telemedicine program that was the first of its kind in the nation. Known as ANGELS (Antenatal & Neonatal Guidelines, Education and Learning System), the award-winning network linked physicians around the state when it began in 2008. Now 53 of the state’s 80 hospitals are connected in a telemedicine network. (Source: Flick 2008: UAMS/Johnpaul Jones)

Telemedicine may be used to treat acute, short-term health issues such as accidents, strokes, planned or unplanned surgeries, or heart attacks. Long-term telemedicine treatments take over after the initial trauma, diagnosis, or other medical events. Different treatments, different broadband. 

For communities that expect telemedicine to facilitate acute medical care within a facility or between healthcare facilities, fiber often will be the broadband infrastructure of choice. In fact, among many communities that have their own broadband networks, healthcare facilities are considered anchor tenants on those fiber networks.  

Children’s Mercy Hospital in Kansas City conducts several thousand clinic visits per month, yet only 200 per month are via telemedicine. But they are bulking up their broadband in preparation for an increase in telemedicine activity. “We have a 2 Gigabit per second (Gbps) connection to our main hospital, a 1Gbps to a couple of our smaller facilities, and a 100 Megabits per second (Mbp) and 50 Mbps fiber lines to our clinics serving rural communities,” said John Baker, Senior analyst of telemedicine and video for Children’s Mercy.  

Maximizing telemedicine for long-term healthcare may require different broadband strategies and technologies. Certain communities may want to emphasize senior care or mental health issues, and this could lead to partial network buildouts or network enhancements. Inviting some telemedicine vendors to participate in planning might be wise. Expect fixed wireless to have a big role. 

Partnering with the state and others benefits telemedicine 

Arkansas used to lead the United States in stroke deaths. In 2008, the Center for Distance Health at the University of Arkansas for Medical Sciences (UAMS) partnered with the Arkansas Department of Human Services to form Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES). Now 53 of the state’s 80 hospitals are connected in a telemedicine network. 

Before the program, less then 1% of stroke patients statewide received the de-clotting drug alteplase (tPA), the leading treatment for strokes. Many hospitals, especially rural ones, are staffed with family care physicians who didn’t feel comfortable taking the risk of administering this drug.  

“Since AR SAVES started, we’ve gone from 1% to 33% of the patients in those hospitals who qualified for the program to receive tPA,” says Roy Kitchen, Arkansas e-Link Director. “The other 67% didn’t suffer a serious enough stroke or in some other way broke the established protocol.”

Donna Richardson, RN, is a Nurse Project Manager at UAMS in the Center for Distance Health. Her work with telehealth and telemedicine began in the ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) Call Center with programs such as telephone triage for high-risk pregnancy. (Source:


AR SAVES operates across a fiber backbone called Arkansas Research Education Optical Network (ARE-ON). ARE-ON owns a statewide high-speed fiber optic backbone network with 1Gb and 10Gb ethernet connections. Each hospital has its own clinical equipment for the telemedicine operations. A number of healthcare providers also can connect with nearby small clinics for video consults or other services. 

“We share ARE-ON with several other health and telehealth programs throughout the Arkansas hospital systems, including a huge trauma care program,” said Tina Benton, director of the Center for Distance Health. “For example, if there was a big explosion near one of the hospitals, that’s where patients could be triaged and treated in consultation with specialists at other hospitals via telemedicine. There are only 16 burn injury beds in Arkansas.” 

Long-term telemedicine requires creative partnership, multiple vendors 

For communities that want their constituents to have the variety of applications and services that telemedicine offers for long-term healthcare, they too need significant planning and coordination. From a broadband perspective, a network may have to go far beyond a healthcare facility.  

In the past, community broadband providers may have been advocates of only fiber or only wireless infrastructure. In the last year or so, communities are increasingly deploying hybrid networks that combine different broadband technologies. Necessity may dictate the network be comprised of fiber, cellular and fixed wireless, and even cable. 

The opioid epidemic is particularly felt in East Tennessee. And where there is street-use of opioids, there is also an increase in hepatitis C and HIV.  

“Access to quality, competent healthcare has been a challenge,” said Matt McAdoo, COO of Choice Health Network. “Federal, state and private grant money made it possible for us to create a sizeable clinic and telemedicine operations in Knoxville to meet these challenges.” 

Choice Health Network’s telehealth suite is housed in a clinic and interacts with six other telehealth sites.  

“Our telemedicine model works because we provide our own healthcare providers that include medical case management professionals, primary and infectious disease care physicians, mental healthcare, and a peer health program,” McAdoo said. 

It took a year to put these professionals into place, and the telehealth program launched in January of this year. 

Their long-term telehealth treatment includes getting patients diagnosed for conditions like HIV, scheduling appointments with medical providers, and prescribing medication. Then the staff monitors patients and encourages them to participate in ongoing care. Treatment includes steps to reduce the threat of infection to others. 

Expect long-term telemedicine apps to profligate 

The potential for telemedicine and broadband to cut costs and increase efficiency of long-term healthcare is enormous. 

“I agree that the emotional aspect of what telemedicine achieves … can encourage a potential subscriber to sign up for a community network,” said Steve Hendrix, president of m.Care, a telemedicine vendor of remote patient monitoring systems. “When we have chronically and critically ill patients who are frequently admitted to the hospital ER, telemedicine can reduce the frequency that can otherwise result in 40% to 50% of the healthcare cost treating a patient.”  

McAdoo at Choice Health Network in Tennessee said their first-year goal is to do 25% of treatment through telehealth, with a higher goal for mental health patients. “Currently we are using these telemedicine hubs for delivering treatment, but it’s also our goal to deliver telemedicine directly to patient’s homes,” he said. 

Broadband is the essential ingredient in telemedicine. With evolving technology, there are more bluetooth- and USB-enabled diagnostic and other medical equipment that people can use from home –  assuming they have sufficient broadband connectivity. With the right tools, home-bound patients can play active role in wound management, chronic illness management and overall wellness improvement.  

Sincere apologies to Star Trek, but this is not the final frontier. Telemedicine is the new frontier for this century – if we can just get broadband everywhere it needs to be.  

Craig Settles  is a community broadband consultant, a broadband business planner, and author of  “Building the Gigabit City.” He is a speaker at Broadband Communities Summit in Austin, Texas, in May. 

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