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Lack of Broadband Hinders Telemedicine in Rural Areas

Telemedicine has been touted as a way to fill in some gaps in health care for rural residents.  But telemedicine relies on broadband service, which parts of Appalachia still don’t have.

“Without broadband, you don’t have telemedicine,” said nurse practitioner Lindsey Kennedy. Kennedy manages the telemedicine program at Bland County Medical Center in southwestern Virginia.

The clinic is located at that tip of Virginia that curves down between West Virginia, North Carolina, Tennessee and Kentucky. Kennedy said patients from all of those states utilize the clinic’s telemedicine services.

The Bland clinic is a federally qualified health center, which means that many of the clinic’s patients are uninsured or underinsured. Without telemedicine, patients needing specialty care have to drive to a hospital that offers financial assistance, which could be hours away.

“But it’s just not feasible for our patients to drive that far and to provide the finances for transportation and the time for that,” said Kennedy.

Telemedicine offers a way to bridge that gap. People drive to the clinic, which is centrally located, and then have consults with doctors at the University of Virginia Medical Center in Charlottesville.

“I think there’s been a clear communication in this country that rural people need access to resources,” said David G. Cattell, director of telemedicine for UVA. UVA works with 150 rural clinics like the one in Bland County. West Virginia University also has a telemedicine program as does the University of Kentucky.

However, much of the region lacks adequate broadband access, which is defined as download speeds of 25 megabits per second and upload speeds of 3 megabits per second. Even in areas that have some access to broadband, like the Bland Clinic, it isn’t always enough.

“We are working with Carillion to do cardiology clinics,” said Kennedy, “because a lot of our patients have heart attacks. They’re flown out to Roanoke and are expected to follow up in Roanoke,… [but] a two hour drive for a 90-year-old, elderly woman is not feasible.”

The clinic had to add an additional IP address to be able to electronically connect to the hospital system. But there’s only one internet provider in Bland, and they weren’t in rush to get the project done.

Installation “took six months. It was something that could have been done in a day,” she said.  “But because we only have the one carrier in the area, they took their time with it. …They knew we didn’t have anyone else to go to.”

Now UVA is expanding telemedicine into the local school system, yet Kennedy said everyone’s pretty nervous about whether the school’s internet will be fast enough to manage the task.

“I mean a lot of people don’t think about it, but that’s your fundamental for telemedicine – you have to have that connection so you have that flawless face-to-face encounter,” she said.

Telemedicine uses videoconferencing to create face-to-face encounters between a patient and provider – think Skype or Facetime on steroids.

“We have accessories that you can plug into…  If you have to listen to heart or lung sounds, they have a stethoscope you can plug in,” said Kennedy.”Then on my end, I’ll hold it up to the patient, just as if I was doing an assessment and on their end they’ll be able to hear those sounds.”

Recently the federal government has taken steps to expand broadband in rural America. In April, the U.S. Department of Agriculture announced grants of nearly $12 million to help establish broadband access in rural areas.

Some states, however, have declined to add their tax money to the cause. Last January, West Virginia legislators proposed a bill to create a $72 million state-run broadband network. But the bill was never put to a vote in the House in the absence of support from some Republican members.

Both Kennedy and Gordon-Cattell emphasize that without broadband you can’t have telemedicine.

“We as a nation need to commit to full-scale broadband. Broadband is that place where education, economic development and health are interdigitated,” said Gordon-Cattell.

Gordon-Cattell said in the end rural broadband isn’t just about healthcare – although that’s desperately needed. He said broadband can bolster rural economies by helping rural hospitals stay open and creating technology jobs.


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