The following article was published by Government Technology on June 5, 2020.
“Social determinants of health” is a hot topic among government and health system executives. The phrase usually refers to basic food, housing and transportation disparities that can lead adjoining ZIP codes to have drastically different life expectancies. But could lack of broadband Internet access also be considered a social determinant of health? Many rural health advocates say yes, and they are trying to do something about it by pushing for the infrastructure to enable telehealth programs and remote patient monitoring.
Broadband is defined as high-speed, reliable Internet with actual download speeds of at least 25 megabits per second (Mbps) and upload speeds of at least 3 Mbps. It can be delivered via fiber, wireless, satellite, digital subscriber line (DSL) or cable. According to a 2019 Pew Trust report, 60 percent of health-care facilities outside of metro areas lack broadband access.
Researchers have a name for areas that have both low rates of home broadband and higher-than-national-average mortality rates for cancer and other diseases: “double-burdened counties.”
The Federal Communications Commission’s Connect2HealthFCC Task Force has created a mapping platform that allows for the overlay of cancer mortality and other disease conditions with broadband access coverage. This allows them to pinpoint hot spots. In these areas, for example Appalachia, the task force found that more than 70 percent of counties with the highest lung cancer incidence and mortality have rural broadband access below 50 percent.
Telehealth efforts have made progress in connecting rural hospitals to academic medical centers to allow specialists to visit with patients and their care providers without arduous travel. But getting broadband access to smaller clinics and individual homes has proven more difficult, because telecom companies don’t find it financially viable to connect homes in rural areas at affordable rates. The FCC and U.S. Department of Agriculture have programs that subsidize the cost of broadband for some rural health providers, but those programs have traditionally been oversubscribed. Therefore, in-home virtual visits and remote patient monitoring for patients with conditions such as cancer, diabetes and chronic heart failure are not as widespread as they could be.
In some Appalachian counties, a trip to Markey might take two-and-a-half hours by car, but for many people with financial and transportation challenges, it might as well be on the other side of the moon, Ahern said. “People understand that if we could deliver some aspects of cancer care remotely, it would improve outcomes. Gaining connectivity into those counties is crucial.”
“One of the rationales for the collaborative is that we could take an informatics approach to identify targeted communities and work with the National Cancer Institute to try to deploy a user-centered design approach to create tools to improve cancer care in that region,” Ahern said. The co-creation concept is key, he explained. Rather than having experts coming into a rural area and saying, “We have a solution for you,” the idea is that to be successful, solutions that are meaningful and likely to be used in areas with particular cultures have to be built with lots of input from participants.
The first use case involves doing online distress screening for cancer patients. Research has shown that monitoring patient-reported outcomes through a Web portal actually lowers mortality rates among cancer patients, Ahern noted. Accrediting agencies of cancer centers require distress screenings, “but they have been done in a haphazard way in paper form,” he explained. LAUNCH is making the process electronic and building the workflows around responding quickly if patients rate their stress levels very high.
Ahern emphasizes that the project is not just about connecting doctors and patients. “We want to engage caregivers, family members, community health organizations and church leaders who can be part of a broader solution enabled by connectivity,” he said. “Fundamentally, it isn’t just putting in the broadband and walking away. We are looking at infrastructure as a core element to broaden the ecosystem.”
In its contribution to the project, the FCC is talking to companies and associations in the telecom industry to step up and assist wherever they can. And there’s been a lot of interest from companies wanting to be part of LAUNCH, according to Ahern. “Given the COVID-19 epidemic, there is a recognition that we need to have an all-hands-on-deck approach wherever there can be better connectivity that will save people’s lives, so the industry is poised to do that more rapidly than they might have otherwise done. We are working on that pretty diligently right now, particularly with satellite providers. We think there are some immediate opportunities there.”
During a summer 2019 LAUNCH project meeting, FCC Chairman Ajit Pai described a recent trip he had taken to Allen County, Ky., an economically challenged rural area near the Tennessee border. The school system there has more than 3,000 students — but not one pediatrician. The nearest one is a decent drive away in Bowling Green. “But now, thanks to broadband, local students can see a pediatrician simply by walking down to the school nurse’s office,” Pai said. “There, they can be seen virtually by a top-notch physician from Vanderbilt University’s Children’s Hospital, which has a partnership with the school district,” he said. “Think about what a difference all this makes: Students are healthier, parents worry less and don’t have to take time off work, and teachers can focus on teaching.”
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