“One prospect’s broadband connection was so poor the audio was always out of sync,” said Jennifer Amis, CEO of Encounter Telehealth. “It was a group of 15 facilities and we weren’t able to connect with any of them. I’m sure all of those patients need specialized care they can’t get.”
Telehealth vendors such as Encounter have the frustrating experience of seeing their best efforts to serve rural populations thwarted by pathetic broadband connections. Or worse, no broadband at all.
At least vendors and healthcare facilities have the benefit of serving urban areas because there, the broadband is always good. Or is it?
The Myth of Urban Broadband
“The public has been misinformed,” said Eric Brown, president of California Telehealth Network (CTN). “Often in the public discourse when telehealth is discussed, rural health gets the headlines. There’s no doubt that the rural areas need assistance. But there’s a lot of work still needed in urban areas, more than people think.”
CTN’s primary goal when they started in 2013 was, and still is, to serve the rural communities of California. But as they move forward, they also expanded their focus into other settings where they didn’t serve initially.
Urban broadband availability is still a problem. Cities suffer from the legacy of broadband’s origins. Brown noted:
As a former cable operator I know that in the early days of broadband there was more of a focus on the suburban areas than on the inner city communities.”
Broadband everywhere also suffers from an acute lack of competition, which is why more than 750 municipalities and electric co-ops have built their own broadband networks.
“When you talk about a solid wired competitor, there really is none against Verizon, Comcast, Time Warner and the other large telcos in their respective markets,” says, Anne Schwieger, broadband and digital equity advocate for the city of Boston. ‘These companies rarely go into each other’s territory.”
Telehealth practitioners and vendors need to have a firm grip on the realities of broadband coverage in urban and rural communities because you can’t have telehealth if you don’t have good Internet access.
Compare the total numbers of households with the percentage of those without fixed broadband in various cities from the 2016 American Community Survey, which revealed the most disconnected large and midsize U.S. cities. The numbers paint a stark picture of just how serious our digital divide is in urban American:
| Brownsville, Texas | 33,711 | 67% |
| Detroit, Michigan | 147,067 | 57% |
| Hialeah, Florida | 42,258 | 56% |
| Shreveport, Louisiana | 38,200 | 51% |
| Memphis, Tennessee | 126,428 | 49% |
| Cleveland, Ohio | 81,757 | 49% |
| Laredo, Texas | 33,077 | 47% |
| Miami, Florida | 81,424 | 47% |
| Jackson, Mississippi | 30,351 | 47% |
| Topeka, Kansas | 23,775 | 46% |
#1 Determine Your Role in Community Broadband
“Healthcare facilities and by extension telehealth providers, particularly in rural areas, can serve as anchor tenants that help solidify business cases in community broadband projects,” said Ben Lewis-Ramirez, business development manager at Foresite Group.
“In big cities, funding a network strictly with revenues from telehealth will be a more challenging case to make. You may have to build limited-reach networks to serve the un-served or underserved communities,” he said.
#2 Lobby on Behalf of Local Healthcare Professionals and Patients
Chattanooga, Tennessee, has a public gigabit network is incredibly popular. Dr. Davis and her staff use Chattanooga’s network in the office and their homes. “Our practice (In Good Health) built its reputation on the long-term relationships we have with our patients, and telehealth enables us to bring additional value to those relationships,” said Dr. Davis.
The practice is participating in the city’s telehealth pilot program.
#3 Pilot Test on Community Broadband
Organizations often run pilot tests to determine if the technology works as advertised, that end users are comfortable with the technology, and how well the product will adapt to the organizations needs. Telemedicine pilots should be conducted with community broadband subscribers to also test various marketing approaches and messages.
Whether your community (market) is rural or urban, and whether they already have a community broadband network or plan to do one soon, many will find it valuable to execute a pilot program to test telehealth.
Depending on this pilot’s results, they may decide to build community-owned infrastructure just for the telehealth.
Besides testing technology, an effective pilot can assist the network’s management. The community can verify the intended telemedicine benefits by providing feedback on different types of telehealth apps and services as well as feedback on the marketing tactics and messages.
Telemedicine pilot tests may require a lean team that consists of the appropriate community stakeholders.
James Cowan, CEO of Docity, advised, “The team should pick the telemedicine apps to be tested, but also get ample input from the community within the geographical area for the pilot test.”
Broadband owners should use smart demand aggregation (needs assessments) to determine which neighborhoods want telemedicine over the network. Engineers often build networks that ‘follow the money’ and potential revenue for the city and service providers.
Good software can determine the north side of town has a heavy senior population, for example, and subsequently you offer them telehealth monitoring services to check on people’s well-being within the home,” said Isak Finer, chief marketing officer at planning software vendor COS Systems. “Or the east side has a population with a tendency for diabetes, so you can recruit telemedicine app vendors for this part of town.”
If you’re going to partner with community broadband network owners, conduct good needs analysis, patiently execute proper due diligence on your partners and do your homework, especially in urban areas.
“Our platform works well over cellular,” said Amis. “However, if an area has bad broadband they probably have bad cell phone reception as well.”
