This issue of the digital divide wasn’t unique to Houston, the disparity in internet access was happening across America. In fact, in 2019, the Federal Communications Commission estimated that over 20 million Americans didn’t possess strong broadband access.

In  July, I was tasked to lead a new nonprofit organization in Houston called Link Health. At Link Health, our organization leverages the health sector to connect patients to the Affordable Connectivity Program and close the digital divide in healthcare.

The organization was founded by an emergency room physician and Harvard University Professor, Dr. Alister Martin, who tapped university students to serve as fellows and digital equity ambassadors. The fellows and ambassadors are placed in clinics and hospitals to actively enroll patients into the Affordable Connectivity Program while they wait to see the doctors. These college students are attacking the problem with fervor and urgency!

In Houston, over 400,000 households are eligible for the Affordable Connectivity Program, but there has only been a 30% adoption rate. Through our partnership with healthcare systems like Legacy Community Health, San Jose Clinic and Lone Star Health Center we have an opportunity to enroll over 200,000 people who are current patients of those systems. In our work, we found that many of those patients that are eligible for the Affordable Connectivity Program need support in completing the application, uploading documentation and then getting the actual discount applied to their internet service account. Our team is there from start to finish in this process.

Although our program is new, we have found success in our clinic- to- community partnerships. Our team has screened over 10,000 patients and enrolled almost 1,000 families into the program. We estimate that through Affordable Connectivity Program enrollments we have helped families save over $290,000 on home internet and our work is just beginning.

We recognize that the Affordable Connectivity Program is slated to sunset when the funds are exhausted. However, in the meantime, our student-led organization will continue to meet people where they are. We will move forward with bringing on new clinical partners and guiding their patients to receive access to these necessary discounts. To broaden our reach, we are sharing resources and marketing material for community health sites that include posters, RX discharge paperwork, brochures and other graphics that promote the ACP.

While news stations are no longer constantly covering stories about students’ connectivity challenges, the issue is still extremely prevalent in many communities. At Link Health we want to assist eligible families in connecting to the internet so that they have access to other resources like telehealth. Opening up access to the internet is one sure fire way to address social determinants of health and we are poised to connect people to the world.

Ar’Sheill Monsanto is the manager of Link Health, which connects patients to broadband access. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

“Don’t write them off just because they’re outside your comfort zone or what you’re used to,” said Max Joseph, a business development manager at AT&T. “There’s huge potential to market to these communities.”

Hospitals, doctor’s offices, and clinics often want to provide telehealth – services like counseling and appointments conducted via the internet, said Layne Sisk, CEO of broadband consulting firm ServerPlus. But healthcare providers often lack the technical knowledge to implement the service on their own. 

Photo of the panel at WISPAPALOOZA by Jake Neenan

In rural areas, implementing telehealth can involve getting connected to adequate broadband for video calls.

“To them, this is overwhelming. This is like magic,” he said.

The panel cited HIPAA, the law outlining privacy protections for patient health data, as a common concern preventing broadband providers from approaching healthcare clinics and getting them connected.

But HIPAA requirements, said Vonda Dilley, a sales manager at broadband provider Horizon Connects, are not distributed equally on a network. If a broadband provider only serves a clinic with internet connectivity, its compliance requirements are lower than the clinic’s internal IT systems and patient portal.

“You’re considered a conduit,” she said.

Expanding telehealth in rural areas can benefit those communities by giving them easier access to healthcare, plus specialists that are physically far away.

“The idea behind this is not just to make it more convenient, it’s a better quality of care,” Sisk said.

He pointed to a counseling center that operates in the same building as his office. During the pandemic, he said, that counseling center was able to see patients with more severe mental health because of the easier access to remote sessions.

The Federal Communications Commission launched a three-year pilot program in 2021 to study the impacts of making telehealth a permanent part of the Universal Service Fund, a roughly $8 billion yearly internet subsidy program.

His point? Springfield learned a valuable lesson: Teens push the edges of technology, and understand how to use technology better than many adults do. Therefore, it is imperative to include teenagers in the planning of what is and will be their main future technologies. The brain power and the creativity alone will lead to the success of tapping this demographic.

Fast forward to 2023. How many communities are leveraging their teen populations in the pursuit of broadband and digital equity? “Kids want to get a look into the future,” said Kevin Morris in a video. “That’s the thing that drives many of them in school.” Morris talks to many students as the director of college, careers and community services for the Duarte Unified School District.

What about their future in broadband, I wondered, when a friend talked to me about her efforts to recruit internship positions for the K12 Foothill Consortium? Many of the high school students in the Consortium are anxious to intern remotely or in-person near their homes in Southern California. It hit me — take the Springfield model of teen engagement to the rest of America!

Imagine the possibilities for local broadband or digital equity teams, local government and nonprofits if they can channel bright, tech-savvy, energetic, inquisitive teens on a mission to help bring the digital equity solutions to communities. Remote or in person interns can help with focus groups, town halls logistics, preparing and writing newsletters, usability testing and Affordable Connectivity Program enrollments.

The K12 Foothill Consortium is recruiting internship hosts for the June through August period and for at least 60 hours total. Those groups and organizations engaged with broadband and digital inclusion projects get the benefit of interns’ prior training in coding, health care, web design, engineering and other related disciplines. Since interns prefer paid internships, the Consortium also raises money for organizations that may be too cash-strapped to offer a stipend but can offer meaningful internships.

Photo of Career Technical Education students courtesy of the K12 Foothill Consortium

Internship hosts view the relationships as a win-win for everyone involved. Ivan Ayro, director of adult and career technical education at Charter Oak Unified School District, agrees. “Students are able to connect the educational experience they’re getting from Career Technical Education classes with real-life experience from workplace learning. Through the internships, many of our students are able to realize in high school if this is something that they want to do for the rest of their lives.”

A recent US News & World Report article states that, although internships are traditionally for college students, high school students increasingly are participating in them. Benjamin Caldarelli, co-founder of Princeton College Consulting, a New Jersey-based educational consulting company, said, “High school students want to work somewhere that interests them and potentially make what they feel is a more meaningful contribution. They see internships as an enrichment activity and opportunity to make an impact rather than simply trading time for a little money.”

More than 205,000 new jobs will need to be created to complete the Broadband Equity, Access and Deployment expansion plans, many of them skilled workers. “There is a lot of focus placed on building broadband networks, but we cannot build them without a proper workforce,” Fiber Broadband Association CEO Gary Bolton said in a press release. “Failure to ensure the availability of high-skilled labor will result in workforce bottlenecks, which will ultimately lead to higher costs and project delays.”

The National Telecommunications and Information Association is requiring every state to have a five-year workforce development strategy. FBA published a guidebook to help states develop that strategy. Broadband and digital inclusion teams need to pencil in “internships” as part of their plans.

High school broadband and digital inclusion interns may not be considered skilled workers, obviously, but the interns should be considered the beginning levels of workforce development campaigns in every community. Start people thinking about broadband and all things digital in high school and use internships to shape their college or post-high school plans. Don’t forget that Gen Z can be an important part of broadband discussions, even if they’re not interns.

Amy Foell, principal of Amy Foell Consulting LLC, heads the K12 Foothill Consortium for Azusa, Charter Oak, Duarte and Monrovia Unified School Districts’ CTE. Their mission is to educate and train students to provide a community-sourced talent pool to sustain a healthy, balanced, local economy. Foell also supports workforce development programs across the San Gabriel Valley, including Pasadena Unified School District.

“I like to have an initial phone call and 15 to 20 Zoom sessions to ensure prospective internship sites understand the program,” said Foell. “Before we meet, it’s advisable to create a brief description of the internship project — be sure to share the organization’s purpose and mission. We’ll help hosts identify and interview candidates in May to early June, and students can start mid-June.”

Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

TAPs are self-contained spaces that are furnished with an internet connection, a computing device equipped with a camer­­­­a, speaker and microphone, and a dedicated private room or kiosk open to the general public. It is telehealth broken down to its essential elements.

A TAP could be a blessing if a person having a mental health crisis needs a safe place. Rural residents can find TAPs are low-pressure environments to try out telehealth. TAPs at trusted places such as barbershops, hairdressers, or churches are places to go for appointments when people don’t have Internet accounts, laptops or their smart phone is data-capped out.

“The Find Telehealth app located at our webssite is a tool that helps people find TAPs if they need them, and the app will help these established TAPs become better utilized by their communities,” said Jaleen Johnson, program manager for the Northwest Regional Telehealth Resource Center and the Utah Education and Telehealth Network. “TAPs are scalable at many different levels. These typical locations you’ve described would have the basic necessities for a TAP, though some across the region have added features.”

Nicki Perisho, program director for NRTRC, continued, “Currently TAPs are live, but we have been marketing it as only being available in the Northwest Region (Alaska, Washington, Oregon, Montana, Idaho, Wyoming, Utah). Not all the regional TRC’s have the same telehealth mapping functionality. There is another mapping project being utilized by five of the other TRCs that is still in beta testing.”

Location data can be entered by NRTRC, individuals that run the TAPs and individuals independently finding TAPs after NRTRC verifies it. TAPs do not provide medical services, just access to the Internet and a device to connect to a telehealth appointment. There is no charge for that access at this time.

TAPs, strategically speaking

TAPs have a wonderful potential to impact telehealth deployments, especially if communities maximize TAPs’ public health value with a plan, some thought and a little kick-ass marketing strategy.

Every state is working feverishly to produce statewide broadband plans as well as digital inclusion plans by in Fall. Then true craziness begins as local broadband teams start jockeying for millions of federal and state dollars. Public health official and stakeholders need to leverage these planning activities with health needs assessment to determine where TAPs can play.

Poor people are in a crisis of poor health!

Right off the bat there’s a market need for TAPs because 25 percent of U.S. homes do not have internet access, often due to affordability issues. A little research will uncover that those who can’t afford broadband have trouble keeping food on the table, they don’t have insurance or regular doctors, and they have a higher propensity to be chronically sick or unhealthy. Consider broadband and telehealth the double-edged sword of digital health.

Health Affairs, a leading journal of health policy, wrote recently that “Poor adults are five times as likely as those with incomes above 400 percent of the federal poverty level to report being in poor or fair health. Low-income Americans have higher rates of heart disease, diabetes, stroke, and other chronic conditions, compared to higher-income Americans.” TAPs can or should be a part of every digital equity plan.

TAPs are ideal for trusted spaces

In Cleveland, two Urban Kutz barbershops have been screening customers’ blood pressures for 12 years. Owner Waverly Willis said, “I find at least 90 percent of my customers have high blood pressure, and many don’t know about the dangers of hypertension.” Other than the church, there’s not a more trusted place for TAPs to find sanctuary than the barbershop or hairdresser for African Americans.

And speaking of the church, quite a few churches of every domination worked overtime tackling COVID-19 prevention and detection. Often there were lines at the door and down the street for COVID testing and vaccinations. Thematically and logically, churches where you go to heal the sick or better yet, prevent illness and sicknesses in the first place. Move from church TAPs to telehealth in the home.

“The general principle of TAPs fits well with a specific initiative that addresses middle mile and anchor institution priorities, what we’re calling Connectivity Hubs,” said Andrew Butcher, president of the Maine Connectivity Authority. “A perfect example is a library system that will be upgrading a facility for telehealth utilization, device lending and infrastructure upgrades.” It seems logical to integrate public library systems with TAPs.

TAPs are good for the telehealth ecosystem

Digital equity needs an ecosystem that includes telehealth, and TAPs can be part of the picture. Wireless ISP Vistabeam launched their Empowerment Center in Torrington, Wyoming to foster digital inclusion among residents. The Center has a fulltime digital navigator, telehealth tools and capabilities, and remote doctor visits. Community facilities such as the Center can be added to the TAP map.

“It’s interesting to me because I can see TAPs becoming a part of an ecosystem since we recognize that telehealth is a priority,” said Brandon Carson, Executive Director of the Pennsylvania Broadband Development Authority. “We’re investing into a deployment to improve access in areas and we’re looking to future proof of these networks as well. We are developing our programming to account for new innovations like these TAPs.”

Jason Welch, Infiniti Mobile President, said, “By expanding the ecosystem beyond broadband and telehealth providers to also include healthcare organizations themselves, there’s a unique opportunity to educate as well as treat patients.” TAPs, besides giving individuals access to telehealth, can also be health education centers.

It’s time to work plans for TAPs into the fabric of digital inclusion and broadband infrastructure plans. Start your planning with the National Consortium of Telehealth Resource Centers and pick the TRC for your particular state. These centers provide consultation, resources and news at no cost.

Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

U.S. Census Bureau Household Pulse Survey data revealed 22% of the U.S. population used telehealth services in 2022. As the 60s ad said, “You’ve come a long way, baby!” Much of the general public is now familiar with the basic virtual doctor visit.

But are state and local broadband teams on board with using telehealth to drive broadband adoption? Here are three pilot programs that address urban social determinants of health (Chattanooga Tenn.), family mental health delivery (Kansas City, Missouri), and a developing digital equity ecosystem that includes telehealth (Torrington, Wyomin). These pilots offer valuable lessons in driving ACP enrollments.

Much of digital health requires broadband infrastructure and computing devices. “When one looks at healthcare and technologies in the App Store today, there are over 400,000 healthcare-related apps, not to mention content items available on the Web” said Equiva CEO and Co-Founder Nir Altman.

Accepting that telehealth is one logical path to broadband adoption, pilot projects are one method for verify the impact on broadband adoption.

Chattanooga pushes the envelope – again

Chattanooga and their urban broadband network are a booming success story, and they are moving to the next level by distributing 1,000 free telehealth accounts in a pilot to impact the social determinants of health one of most economically blighted area in the city.

Digital equity meeting at the Enterprise Center in Chattanooga

“Our pilot project is bringing a variety of resources to a beautiful but under-resourced neighborhood called Orchard Knob,” said Deb Socia, president and CEO of the Enterprise Center, a nonprofit that works at the intersection of technology and inequality. “The neighborhood has high levels of diabetes, stroke, heart disease, asthma. We’re providing home Internet access, digital skills training, and devices.” Some homes are getting energy upgrades and smart thermostats.”

Many Orchard Knob residents work but not at jobs that offer medical insurance, and they earn too much to qualify for the state’s health programs. It will be difficult for residents to mitigate the negative effects of the without telehealth.

The city-owned electric power board, EPB, is critical to success. EPB was part of planning from the beginning, they contributed funding, they will power the telehealth accounts, and EPB is building out free WiFi in public spaces.

The Enterprise Center received a Tennessee Valley Authority award, and their healthcare partner is the Parkridge Medical System.

Eight steps to the pilot

Essential Families is a 501(c)3 nonprofit that conducted a telehealth pilot in one of the poorest communities in Kansas City, MO with stellar results. They delivered mental healthcare for families and also virtual parent education that enhanced parenting skills.

Their pilot has eight steps, starting with:

Step 1. Developing a database of residents who could potentially use telehealth and broadband. 69 homes participated in the pilot.

Steps 2 and 3. Their Chief of Digital Marketing, Kenneth Yancy, said, “We had to go directly to the people to educate them about FCC’s Affordable Connectivity Program (ACP). Our partners such as the school district and childcare providers were part of the needs analysis process.”

Step 4 When residents registered for the pilot and completed their forms, Essential Families gave them free laptops. The incentive motivated residents to provide data that is difficult for government agencies to collect.

Step 5. Each participant was assigned a digital navigator who walked the family through the processes leading to telehealth services, including enrolling with ACP and training for the video streaming platform, computer, and Internet.

Step 6. A minimum of 15 virtual parental education sessions and six mental healthcare services.

Step 7. An extensive follow up by the additional navigator.

Step 8 The pilot evaluation report that is helped significantly by the electronic and manual tools that execute various real-time assessments, impacts, and cost/benefits analysis.

Rural telehealth

Wireless ISP Vistabeam launched their first Empowerment Center in Torrington, Wyoming. The Center offers ACP enrollment help, digital skills training, video conferencing, and Microsoft delivers digital skill programs.

Matt Larson, owner of Vistabeam

“A fulltime digital navigator is on-site, and we are working with a telehealth company to pilot a home test suite that includes an oximeter, blood pressure monitor, and blood testing,” says Matt Larson, owner of Vistabeam. “The device will be part of the Center’s telehealth capabilities, along with remote doctor visits.”

Rural communities need a strong human element for telehealth to succeed, so digital navigators are key elements of the team. The Center draws people in by emphasizing familiarity, knowledge, no pressure, and exploration.

Larson believes digital equity is just one component of a giant ecosystem of social services to help take care of people. However, there can be a lack of coordination between many of these resources. Effectively coordinating these resources is the way to get maximum collective impact from the ecosystem. The Center staff connects people with complementary social services and other resources.

The quality of broadband infrastructure is key to telehealth success – it cannot fail customers! “The soul of a broadband deployment is in that relationship between an ISP and the customer,” says Larson.

Piloting innovation

Communities need to understand that telehealth is not connections just between doctors and patients. “It’s not up to the patient alone, but also loved ones and care providers in a collaboration that occurs in the care process,” said Altman. “There are many supports groups such as the Cancer Support Community  that supports hundreds of thousands of patients and loved ones.”

The broadband infrastructure supporting telehealth should pilot test these many-to-many connections and resources to be sure they are supported. Pilots should include tools that enables patients, urban and rural activists, and communities to do their own healthcare needs assessment as well.

Jason Welch, Infiniti Mobile president said, “By expanding the ecosystem beyond broadband and telehealth providers to include healthcare organizations themselves, there’s a unique opportunity to educate the patient. ‘Here’s your device and software, and here’s how you maximize the value of their use.’”

If a city’s telehealth pilot is driven by the creation orientation, a community builds or invents things that didn’t exist before. With the creation orientation, you reduce tunnel vision because you’re always pushing the envelope of innovation.

Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

The proposal would ensure providers give “timely and actionable information” on 988 outages that last at least 30 minutes to the Health and Human Services’s Substance Abuse and Mental Health Service Administration, the Department of Veteran Affairs, the 988 Lifeline administrator, and the FCC.

The commission is also asking for comment on whether cable, satellite, wireless, wireline and interconnected voice-over-internet protocol providers should also be subject to reporting and notification obligations for 988 outages.

Other questions from the commission include costs and benefits of the proposal and timelines for compliance, it said.

The proposal would align with similar outage protocols that potentially affect 911, the commission said.

The notice comes after a nationwide outage last month affected the three-digit line for hours. The line received over two million calls, texts, and chat messages since it was instituted six months ago, the FCC said.

The new line was established as part of the National Suicide Hotline Designation Act, signed into law in 2020.

The idea behind the database, which was adopted by the commission in 2019, was to figure out the cost difference between similar broadband services in urban and rural areas in a given state so the commission’s Telecom Program can subsidize the difference to ensure connectivity in those areas, especially as the need for telehealth technology grows.

But the commission has had to temporarily provide waivers to the rules due to inconsistencies with how the database calculated cost differences. The database included rural tiers that the commission said were “too broad and did not accurately represent the cost of serving dissimilar communities.”

FCC Chairwoman Jessica Rosenworcel gave an example at Thursday’s open meeting of the database calculating certain rural services being cheaper than in urban areas, when the denser latter areas are generally less expensive.

As such, the commission Thursday decided to revert the methods used to determine Telecom Program support to before the 2019 database order until it can determine a more sustainable method. The database rescission also applies to urban cost determinations.

“Because the Rates Database was deficient in its ability to set adequate rates, we find that restoration of the previous rural rate determination rules, which health care providers have continued to use to determine rural rates in recent funding years under the applicable Rates Database waivers, is the best available option pending further examination in the Second Further Notice, to ensure that healthcare providers have adequate, predictable support,” the commission said in the decision.

Healthcare providers are now permitted to reuse one of three rural rates calculations before the 2019 order: averaging the rates that the carrier charges to other non-health care provider commercial customers for the same or similar services in rural areas; average rates of another service provider for similar services over the same distance in the health care provider’s area; or a cost-based rate approved by the commission.

These calculations are effective for the funding year 2024, the commission said. “Reinstating these rules promotes administrative efficiency and protects the Fund while we consider long-term solutions,” the commission said.

The new rules are in response to petitions from a number of organizations, including Alaska Communications; the North Carolina Telehealth Network Association and Southern Ohio Health Care Network; trade association USTelecom; and the Schools, Health and Libraries Broadband Coalition.

“The FCC listened to many of our suggestions, and we are especially pleased that the Commission extended the use of existing rates for an additional year to provide applicants more certainty,” John Windhausen Jr., executive director of the SHLB Coalition, said in a statement.

Comment on automating rate calculation

The commission is launching a comment period to develop an automated process to calculate those rural rates by having the website of the Universal Service Administrative Company – which manages programs of the FCC – “auto-generate the rural rate after the health care and/or service provider selects sites that are in the same rural area” as the health care provider.

The commission is asking questions including whether this new system would alleviate administrative burdens, whether there are disadvantages to automating the rate, and whether there should be a challenge process outside of the normal appeals process.

The Telecom Program is part of the FCC’s Rural Health Care program that is intended to reduce the cost of telehealth broadband and telecom services to eligible healthcare providers.

Support for satellite services

The commission is also proposing that a cap on Telecom Program funding for satellite services be reinstated. In the 2019 order, a spending cap on satellite services was lifted because the commission determined that costs for satellite services were decreasing as there were on-the-ground services to be determined by the database.

But the FCC said costs for satellite services to health care service providers has progressively increased from 2020 to last year.

“This steady growth in demand for satellite services appears to demonstrate the need to reinstitute the satellite funding cap,” the commission said. “Without the constraints on support for satellite services imposed by the Rates Database, it appears that commitments for satellite services could increase to an unsustainable level.”

Soon-to-be health care providers funding eligibility

The FCC also responded to a SHLB request that future health care provider be eligible for Rural Health Care subsidies even though they aren’t established yet.

The commission is asking for comment on a proposal to amend the RHC program to conditionally approve “entities that are not yet but will become eligible health care providers in the near future to begin receiving” such program funding “shortly after they become eligible.”

Comments on the proposals are due 30 days after it is put in the Federal Register.

“The Enterprise Center works hard at the intersection of technology and inequality, whether it’s using technology to work efficiency, for learning, or improving personal health,” states CEO Deb Socia. The center is partnering with residents, community organizations and the Parkridge Medical System to identify needs and bring in resources to combat high levels of diabetes, stroke, heart disease, and asthma. 

Vistabeam owner Matt Larsen says, “You can’t just lay down some fiber and routers, then call this a broadband success. Rural areas often lack the human and tech resources necessary for broadband to thrive.” So Vistabeam is designing Community Empowerment Centers to offer communities private telehealth consultation rooms, digital skills and telehealth training, full-time digital navigators and inventory rooms with shared computing devices and equipment.

These and other communities are finding that telehealth increases broadband adoption as well as improves the physical and economic health of residents. Telehealth is the “killer app” that can harness and focus broadband investments into digital inclusions advancements for urban and rural communities.  

A perfect storm for telehealth

Chattanooga’s public broadband network, through a city electric power board that offers both electricity and broadband, is an advantage to telehealth. Socia says, “EPB has a deep connection to the community, and they invest money, technology in public spaces, and energy upgrades in the homes. EPB cares about the health of our community.” (EPB, formerly known as the Electric Power Board of Chattanooga, provides broadband in the city.) Communities without public broadband may have to work harder to find large ISPs with similar levels of commitment.

Communities wanting to leverage telehealth likely will need new strategies for winning and managing grants. You can’t have telehealth without broadband, but the integration of broadband to facilitate telehealth delivery may involve a myriad of people, organizations, and resources besides the network builder. 

For years Chattanooga has had a culture of cooperation among its many civic groups. The nonprofit Orchard Knob had a preexisting collaborative, so when the telehealth opportunity came up as part of a larger “healthy community” initiative, it was it much easier to create a grant of the size that the group currently has.

The community created the Orchard Knob Collaborative, which includes Parkridge Medical Center with their 1000 telehealth appointments, the Orchard Knob Neighborhood Association, Habitat for Humanity of Greater Chattanooga Area and United Way of Greater Chattanooga. EPB contributed money, energy upgrades, and public WiFi. Green Spaces is another nonprofit and the Center provides project management plus various Tech Goes Home digital inclusion programs.

Telehealth opens the door for larger grants. “I think the anticipated grant-raising outcomes are quite specific when you’re producing social determinants of health,” Socia says. “Projects that involve telehealth are a much tougher ‘ask’ for funders and everyone else involved. But at the same time, you can leverage other additional dollars and other partners for a much better healthcare outcome.” 

Telehealth and the ‘human element’

Every state is developing a digital equity plan. How important is telehealth to the success of a digital equity plan? Quite important! But remember that telehealth deployment strategy in rural communities likely could take shape differently than urban deployment. Vistabeam’s Centers represent one approach.

Digital equity in telehealth is just one component of a giant ecosystem of social services that good societies use to help take care of people. The challenge is the need to successfully coordinate scarce resources to get maximum impact from the resources. However, in rural communities there can be a real lack of coordination between a lot of these resources.

“It makes sense to start out by focusing on getting telehealth into some smaller communities at locations where people can come in and access telehealth in an environment that develops trust and familiarity with the technology,” says Larsen. “To do that, we’re going to need a ‘human element’, facilitators such as digital navigators to plug community telehealth into the ecosystem. A lot of rural communities have trust issues with government programs.”

Using surplus office space to create customer service centers

There are plenty of large incumbents’ mobile device showrooms in communities. But these employees tend to be sales-oriented with scripted content. Vistabeam happens to have surplus office space they are using to create true customer service centers.

“We figured out how to train people to be digital navigators, we get customers comfortable with telehealth and our staff connects people with complementary social services and other resources,” says Larsen. For the last few months, Vistabeam has been promoting exclusively the FCC’s Affordable Connectivity Program of free Internet access and subsidized computing devices. There’s a complex enrollment process residents have to complete that’s confusing for many, so Vistabeam trained staff to walk people through the process, get them qualified, and connected.  

As for the potential of telehealth deployment to the home, Larsen believes the technology represents a tremendous amount of potential utility and value for both rural and urban broadband deployments. Though broadband is currently underutilized for telehealth, in large part because communities are just beginning to plan for it, the pandemic revealed a burning need for strong video streaming capacities to bridge doctors and patients.

“What’s missing is a telehealth killer app or device,” says Larsen. “I believe preventive healthcare will be the answer – technology that detects or prevents things from happening before they become big problems. This app could be a way to check vital statistics and watch for health or illness markers. Maybe we’ll see a device connected to the Internet that accesses research data to help you and your health professional with health planning.”  

Just about everybody gets sick or hurt, or they are responsible for others when those loved ones aren’t doing well. Telehealth and its many iterations are designed for people to use when they’re sick or hurt or for preventative healthcare. The universality of telehealth and its symbiotic relationship with broadband technologies give communities great potential for expanding digital inclusion. Together with the bezillion grant dollars coming out the ying yang, what we’re seeing is the perfect digital storm. 

Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

While the FCC has a $200-million COVID-19 Telehealth program, which emerged from the Coronavirus Aid, Relief and Economic Security (CARES) Act, some providers say more money is needed as demand for telehealth services increases.

“The need for broadband connectivity in underserved communities exceeds current availability,” said Jennifer Stoll from the Oregon Community Health Information Network.

The OCHIN was one of the largest recipients of the FCC’s Rural Health Care Pilot program in 2009. Stoll advocated for the need for more funding with the non-profit SHLB Coalition during the event last week. Panelists didn’t specify how much more funding is needed.

Stoll noted that moving forward, states need sustainable funding in this sector. “I am hoping Congress will be mindful of telehealth,” said Stoll.

“The need for telehealth and other virtual modalities will continue to grow in rural and underserved communities,” she added.

Brian Scarpelli, senior global policy counsel at ACT, the App Association, echoed the call for FCC funding from the Universal Service Fund, which subsidizes basic telecommunications services to rural areas and low-income Americans. “I think obtaining funding from the Universal Service Fund would go a long way.”

Artificial intelligence has been used widely across the medical field to analyze relationships between medical providers and patients to improve equality of care, including providing patient risk identification, diagnostics, drug discovery and development, transcribing medical documents, and remotely treating patients.

Carol Horowitz, founder of the Mt. Sinai Institute of Health and Equity Research, argued that while AI plays a substantial role in diagnosing health problems at earlier stages, diagnosing patients more quickly, providing second opinions in diagnoses, enhancing scheduling abilities, stimulating hospital workflow, and finding drug availability for a patient as in dermatology, therapeutics, or population health, it’s not a golden ticket.

She reasoned that it “can reflect and really exaggerate inequities in our system,” negatively affecting healthcare equity among patients.

She stated that AI tools have led to inaccurate measurements in data that have proved harmful to individuals’ health. Horowitz shared the example of faulty AI technology during March 2020 meant to allow individuals to self-monitor their own oxygen levels as a precautionary method to the COVID-19 pandemic but led to inaccurate pulse readings for those with darker skin, and inaccurate data gathering, resulting in delayed treatment for many in need.

Michael Crawford, associate dean for strategy of outreach and innovation at Howard University, added that if these certain mismeasurements and flaws in the technology are not addressed, “AI could increase disparities in health care.”

Alondra Nelson, head of the White House Office of Science and Technology Policy, said when it comes to assessing AI technology innovation for the future, there are both cost and benefits, but we must find “where can we move forward in ways that don’t harm human society but that maximize human benefits.”

As we grapple with how to implement this technology, “we must do science and technology policy that always has equity at the center” for future innovation, said Nelson.

States are required to implement the infrastructure and the funding for a 988 number that will go to the National Suicide Hotline, but only four states have passed bills to finance it, Emily Caditz, attorney advisor of the Wireline Competition Bureau under the FCC, said at a Federal Communication Bar Association event last week. Those states – Colorado, Nevada, Virginia, and Washington – fund the implementation from fees on cellphone lines.

James Wright, chief of crisis center operations at the federal Substance Abuse and Mental Health Services Administration, suggested that “key partnerships between state and local governments” will be necessary to help states meet this deadline.

Laura Evans, director of national and state policy at Vibrant Emotional Health, said this funding will “make sure we have robust capacity for the anticipated 9-12 million contacts we expect to come in that first year.”

The commission ordered the adoption of the nationwide line nearly two years ago, on July 16, 2020.

According to the National Suicide Hotline Designation Act of 2020, “988 is designated as the universal telephone number within the United States for the purpose of the national suicide prevention and mental health crisis hotline system operated through the National Suicide Prevention Lifeline.”

“America’s suicide rate is at its highest since World War II,” said former FCC Chairman Ajit Pai at an FCC event in December of 2019. “A simple three-digit code for a suicide hotline can reduce the mental stigma surrounding mental health and ultimately save lives.

Caditz said the implementation of text messaging “is especially popular with groups that are at heightened risk of suicide or mental health crises, including teenagers and young adults and individuals who are deaf, hard of hearing, deafblind, or speech disabled.”

Digital literacy training will unlock telehealth’s potential to improve health outcomes, according to the event’s experts, including improving treatment for chronic diseases, improving patient-doctor relationships, and providing easier medical access for those without access to transportation.

Julia Skapik of the National Association of Community Health Centers said at the National Telehealth Conference on Tuesday that both patients and clinicians need to be trained on how to use tools that allow both parties to communicate remotely.

Skapik said her association has plans to implement training for providers to utilize tech opportunities, such as patient portals to best engage patients.

Ann Mond Johnson from the American Telemedicine Association agreed that telehealth will improve health outcomes by giving proper training to utilize the technology to offer the services.

The Federal Communications Commission announced its telehealth program in April 2021, which set aside $200 million for health institutions to provide remote care for patients.

The “genius” part was realizing broadband is magic that directly or indirectly enables us to perform minor and major miracles that we could not do before, but faster and easier.

When Craig moved to Alameda, California, situated less than five miles from the heart of Silicon Valley, he could not get cell service without a signal booster, and even then it was sketchy. Several years later the service was better, which allowed him to speed-dial his best friend who called 9-1-1.

The neurologist who set up the stroke center in Alameda Hospital had mirrored much of its technology and servers in her home so she could see everything the ER staff was seeing as they administered life-saving procedures within 25 minutes of Craig’s gurney hitting the ER door.

While Craig counts his blessings, over 14 million urban households do not have broadband in their home – 75 percent of whom are African American and other people of color. Millions more technically have home Internet service but don’t have the connection speeds and capacity to use the applications needed for remote work and school, or telehealth.

And don’t forget the 4 million rural homes that do not have broadband subscriptions.

Broadband as Social Determinant of Health

The essential nature of broadband came to the fore with the onset of the pandemic. And it compelled states and local communities across the nation to take the connectivity crisis far more seriously, especially with the influx of federal funds from the American Rescue Plan Act and the Infrastructure Investment and Jobs Act.

Although advocates commonly, and understandably, tout the importance of broadband access in the context of remote work and schooling, what often gets overlooked are the transformative powers of telehealth and its potential to drive broadband adoption.

It’s no exaggeration to say that broadband is a major social determinant of individual health as it enables access to virtual healthcare and facilitates a host of other things critical to health, such as education, employment, housing, and social services, all of which require broadband, most especially for telehealth applications.

More than video chats with your doctor, telehealth uses high-speed Internet connectivity to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care. Public health, in particular, can leverage telehealth to a great advantage.

Yes, healthcare providers are increasingly integrating telehealth into the delivery of care. But, if the patients most in need of better access to healthcare do not have access to broadband, as well as computing devices and digital skills, tremendous healthcare benefits and cost-savings will be needlessly missed.

This suggests that “fiscally conservative” elected officials, many of whom claim to support universal access to broadband while lamenting the high cost of healthcare, have been thinking about this whole thing backwards. Instead of wailing about the cost of building universal robust broadband infrastructure that could be used for telehealth, why not flip the script?

Achieving universal broadband infrastructure that would last a lifetime would cost on the order of $100 billion, which is just two and a half percent of what we spend on healthcare in this country every single year. Hundreds of academic and industry studies say that even the most conservative telehealth initiatives save more than two and a half percent of system costs.

Talk about a return-on-investment! A hint of this can be seen in a study done by the National Center for Biotechnology Information which found there were as many as 3.5 million potential preventable adult inpatient hospital stays in 2017 alone. That amounted to $33.7 billion in health care costs just for that year.

Telehealth can eliminate many of those stays. And in terms of improving health outcomes, the study further found that the elderly, men, Black communities, and those insured with Medicaid would reap the biggest benefits.

So why not exploit the math, and pay for broadband using healthcare savings? Let’s connect every home, hospital, and community anchor institution in the country to robust broadband, and transform healthcare while bringing it into the 21st century. The municipal broadband model in which local communities build and own the infrastructure is ideal.

Telehealth Can Drive Broadband Adoption

Looking at it this way, universal access to telehealth has the potential to simultaneously solve the connectivity crisis and ensure that millions of families can lead healthier lives.

Here are six tactical ways of using telehealth to maximize public health in a community along with increasing broadband adoption.

1. Re-inventing the doctor’s office visit for a variety of healthcare practices

Understanding telehealth, all you need are four walls, an Internet connection, a computer, a healthcare partner, and a healthy imagination to create a range of practical telehealth solutions.

Transform barbershops and hair salons into Covid vaccination and hypertension screening centers. The school nurse’s office can now become school telehealth centers. Libraries are starting to add telehealth kiosks.

Libraries Without Borders uses interactive Web health content, laptops, and wireless gear to outfit intercity laundromats on Saturdays. Tucson used ARPA funds to build out a wireless network on top of the city’s fiber infrastructure and gave 5,000 low-income homes the ability to have telehealth resources.

2.  Telehealth can marry chronic healthcare, home care, and public health

Frederick Memorial now distributes hundreds of tablet computers for remote patient monitoring  in patients homes to check their vital signs, changing medical conditions and treatments, with data that goes to the hospital daily.

Urban hospitals should partner with ISPs to leverage the FCC’s Affordable Connectivity Program subsidy of up to $30 per month for Internet service and up to $75/month for households on Tribal lands. ACP also offers a $100 discount on computing devices.

3. Enhance the emergency response and Emergency Department to save more lives and money.

African Americans and other populations of color have the highest rates of strokes, heart attacks, and other medical trauma. We could reverse the trend of hospitals that abandon poor urban communities and replace them with city telestroke or telehealth critical care “broadband subnetworks” that are hosted by major hospitals and linked to Federally Qualified Health Center, clinics, and other facilities.

4. Expand efficiency of mental healthcare delivery

Mental health professionals getting to see patients in their homes and therefore providing an alternative to needing to go to a therapist’s office can not only eliminate no-show appointments but can provide those most in need of therapy with broader access to a variety of specialists.

Leveraging telehealth can be especially empowering for underserved communities in which approximately 30% of African American adults with mental illness receive treatment each year, compared to the U.S. average of 43%, according to the National Alliance on Mental Illness.

But as Carly McCord, Director of Clinical Services at the Texas A&M Telehealth Counseling Clinic, rightly points out: “Often we’re talking about intensive therapy, like treating PTSD, which you can’t do with crappy Internet connections. When your patient’s disclosing a trauma and your connection glitches, or you miss a word and have to say, ‘I’m sorry. Can you repeat that? ‘This is a huge problem.”

5. Improving senior care and facilitating aging in place for our nearly 60 million seniors

Three-in-four older Americans want to stay in their homes and age in place, according to a AARP survey. And, if offered a choice, about 53 percent of respondents say they would prefer to have their health care needs managed by a mix of medical staff and healthcare technology.

A key broadband element in this telehealth equation is “smart home” technologies that include wirelessly-controlled sensors. Some sensors now can determine whether a person sat up in bed or actually fell on the floor, if patients are eating regularly, or if they are taking their medications on time.

6. Re-imagining what hospital care can be

In areas prone to natural disasters, make prior arrangements with hotels, college dorms, warehouses, and other facilities where you can bring in generators, computers, telehealth equipment, and wireless intranets.

Use these buildings for seniors with health conditions who have been displaced: people with chronic illnesses and patients with non-serious injuries from the disaster should those people not have easy access to other residential or healthcare facilities.

Building and subsidizing access to robust community-owned broadband networks is a wise investment because it will improve health outcomes and return significant community savings for decades to come.

And with a flood of federal funds available to build broadband infrastructure and advance digital equity, we have a once-in-a-life opportunity to stitch this all together and deliver telehealth for all.

Sean Gonsalves is a Senior Reporter, Editor and Communication Team Lead for the Institute for Local Self Reliance’s Community Broadband Networks Initiative. Saved from a stroke by telehealth, Craig Settles pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth-broadband integration initiatives. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

“Even early in the pandemic, experts agreed that receiving care remotely could both meet many patients’ needs and help prevent community spread of the coronavirus,” Starks said at the FCC’s Connected Health Symposium Thursday. “Now, two years into this pandemic, the Commissioner said “we have ample evidence to show that telehealth made a difference in the national response to COVID-19.”

The FCC’s Telehealth Program was announced in April 2021 and has set aside $200 million for health institutions to continue to provide remote care for patients. The Connected Health Task Force is a working group within the FCC charged with gathering public and private stakeholders to accelerate the adoption of the latest health care technologies.

Americans have embraced telehealth since the onset of the pandemic. Researchers at the Urban Institute found that during the first six months of the pandemic, one-third of Americans have had a telehealth visit for health care.

Lower-income Americans have also sharply increased their use of telehealth services. According to the Center for Medicare and Medicaid Services, telehealth visits for Medicaid and children’s’ health insurance programs enrollment increased by more than 2,600 percent since 2019.

Starks also noted that as community behaviors change while communities lift restrictions, the McKinsey foundation found that telehealth levels have stabilized — to thirty times higher than before the pandemic.

Starks said communities have the opportunity to “leverage once-in-a-generation broadband legislation to expand access to high-quality health care” by enabling greater access to telehealth.

Shira Hollander, senior associate director of policy development at the industry trade group that includes nearly 5,000 hospitals, said at a Federal Communications Bar Association event that the changes she’s seen include increasing options for audio-only telehealth appointments and a wider range of providers providing telehealth services.

Hollander explained the additional benefits of telehealth care, including a “continuity of care” to patients with a “significant drop in cancelled appointments,” an “increase in access to care” for unserved and underserved areas, and help in “providing extra capacity” for healthcare providers, especially in rural areas.

Additionally, the changes brought about by these new funds are hoped to be “catalysts” for future solutions, Hollander said. These solutions are meant to “help in long-term” healthcare.

That being said, Hollander continued, the rise in telehealth “underscores the need for broadband access” and equality.

“Access doesn’t mean equality,” said Hollander.

There were two rounds of applications and funding for the Covid-19 Telehealth Program. The first round, which took place in early 2020, provided 539 funding commitments to healthcare providers and a total $200 million in funding. The second round saw nearly 2,000 applications and resulted in 437 funding commitments to healthcare providers, a total of $256 million in funding. In this round, applications were scored in order of priority, with applications from hotspots of Covid-19, critical access hospitals, and tribal, rural, or low income areas taking first priority.

However, some concern exists over what will happen to telehealth advances made during the pandemic should Congress fail to renew waivers that allowed telehealth provision in government-aligned health programs such as Medicare.

Experts discussed this current juncture in telehealth at a Federal Communications Bar Association event last week.

They remarked on just how quickly telehealth systems were able to grow in the past two years because of Congress’ waivers and the major impacts revoking these waivers could have for these systems and the access of many individuals to healthcare.

A discussed example of virtual medicine’s growth was observed “exponential” increases in new overall patient engagement at Veterans Affairs medical providers through telehealth during some of the deadliest phases of the pandemic.

During a Senate hearing in October, witnesses such as Deanna Larson, president of Avel eCARE, testified that regulatory flexibility from Congress is necessary to address telehealth access, as well as that broadband affordability issues often prevent access to telehealth.

Witnesses also raised that telehealth’s prevalence would increase emergency room bed availability during the pandemic

At the FCBA event, Miller Nash attorney David Rice emphasized that beyond giving medical access to individuals that face obstacles in traveling to medical facilities for treatment, telehealth is simply more convenient than in-person treatment for almost everyone and allows patients to fit medical appointment attendance more easily in their schedules.

In terms of challenges robust telehealth systems would face going forward, Mayo Clinic Platform President John Halamka cited potential licensure issues for providing care, and some argument existed between Rice and Jeffrey Neal, T-Mobile for Government’s national director of federal sales, over whether data privacy issues are likely to be a serious hindrance to virtual treatment.

On Monday, the Federal Communications Commission announced $42.7 million in awards from its COVID-19 Telehealth Program which supports continued care for patients by reimbursing them for telecommunications services, information services and connected devices.

The agency approved 68 additional applications in a fifth announcement for the second round of the program, bringing the total approved to over $208 million for health care providers in each state, territory, and the District of Columbia.

The program supports the efforts of health care providers to continue serving their patients by providing reimbursement for telecommunications services, information services, and connected devices.

“As the impact of new variants continue to challenge our healthcare system, the FCC has worked diligently to review and approve funding commitments as part of our COVID-19 Telehealth Program,” said Chairwoman Jessica Rosenworcel.  “As we head into 2022, the ability to treat patients and loved ones from the safety of their home is of vital importance.”

Some of the biggest awards went to large health care providers such as the County of Los Angeles Department of Health, which received $1 million for the purchase of telehealth software, services, and equipment to deliver real-time video visits with patients.

Sinai Health System, a consortium of five hospitals in Chicago, Illinois, was awarded $1 million for the purchase of devices, such as laptops, tablets, and webcams, along with telehealth software. The award “will allow healthcare providers to offer remote care to vulnerable patients and reduce the risk of COVID-19 exposure,” said the FCC.

The awards also reimburse health care organizations for innovative ideas that connect patients to quality care with broadband. The Westchester County Health Care Corporation in Valhalla, New York, was awarded $1 million for the purchase of remote monitoring software and video equipment, which will allow for the creation of a “tele-ICU” for the provision of remote care for hospitalized patients.

Craig’s tireless work has helped transform the last mile of broadband in the U.S., through his influence among national, state, and corporate decision makers, and his on-the-ground work building community broadband coalitions. Broadband Breakfast Editor and Publisher Drew Clark will interview Craig Settles in this Broadband.Money Ask Me Anything!

Read the Broadband.Money profile of Craig Settles

About Our Distinguished Guest

A community telehealth champion

These are disbursements of the $9.2 billion that were announced in round one of the RDOF reverse auction that took place in the fall of 2020.

The rural fund supports new broadband deployment efforts for 50 broadband providers in 400,000 locations across the U.S. Much of the funding will go to nonprofit rural electric cooperatives to deploy broadband in their service areas.

But others awarded funding under the auction have already defaulted on coverage that they said they would provide as part of their winning bids.

The 26 states ready to receive Wednesday’s funding include Arizona, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New York, North Carolina, North Dakota, Oregon, South Dakota, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.

FCC Chairwoman Jessica Rosenworcel said that the announcement “highlights the agency’s commitment to supporting even more opportunities to connect hundreds of thousands of Americans to high-speed, reliable broadband service while doing our due diligence to ensure the applicants can deliver to these unserved communities as promised.”

The Commission’s announcement comes after the FCC launched the second round of its COVID-19 Telehealth Program on Tuesday, granting $42.5 million for health care providers. This telehealth program and exceeds the FCC’s $150 million goal by reaching $166.13 million for telehealth funding.

These funding programs provide reimbursements for telecommunication and information services and connected devices the providers have purchased to continue their telehealth services. The Commission also announced $421 million on Monday to keep over 10 million students connected across the U.S. as part of the Emergency Connectivity Fund.

Covid-19 often brings about extreme shortness of breath, the severity of which is best assessed by a doctor, Deanna Larson, president of Avel eCARE, told the Senate Subcommittee on Communications, Media, and Broadband, which convened a hearing on the state of telehealth and removing barriers to access and improving patient outcomes.

Patients with affordable, high speed internet access can be monitored at home by doctors so that they don’t enter an emergency room or take up a hospital bed prematurely, she said.

Larson urged Congress to extend or make permanent their regulatory flexibility toward telehealth especially as it relates to being neutral on the kinds of telemedicine, such as phone-only care, asynchronous care, and remote patient monitoring. An economic benefit of which would be keeping medical commerce local, she said. Patients wouldn’t be required as often to move to a higher level of care out of town.

Physicians would have 24-hour access to the patient through video calls, monitoring patients in a way which significantly lightens the burdens of the healthcare system, added Larson. With telehealth, doctors can advise patients on exactly when and if they need to go to an emergency room.

Steps to improve telehealth

The committee also heard testimony from Sterling Ransone Jr., president of the American Academy of Family Physicians. Ransone, a strong proponent of telehealth, has found that the digital divide touches rural, tribal and urban communities alike and proposed a series of steps Congress could take to increase public health through broadband policy, including investing in universal affordable broadband service, digital literacy services, end-user devices, audio-only telehealth and data collection in the determinants and outcomes of telehealth as it relates to key factors such as race, gender, ethnicity and language.

Defining broadband as a social determinant of health, Ransone highlighted that affordability is possibly the greatest barrier to broadband adoption and that affordability and access disproportionately affect rural communities.

Sanjeev Arora, founder of Project ECHO and distinguished professor of medicine at the University of New Mexico, agreed: “expanding access to high-quality, high-speed broadband connectivity is critical. It’s a prerequisite for the success of any telehealth model in rural communities and urban underserved areas.”

Telehealth isn’t just vital and broadly popular, it is cost saving. Federal Communications Commissioner Brendan Carr, who also appeared before the subcommittee, shared an estimate that widespread telehealth availability could save the health care system $305 billion a year.

Carr, in an effort to reduce inessential hospital visits and decrease the risk of spreading Covid-19, endorsed the CONNECT for Health Act, the RUSH Act of 2021, the Telehealth Modernization Act, and the Protecting Rural Telehealth Access Act, which in combination would remove geographic restrictions to telehealth services, foster use of telehealth in skilled nursing facilities, grant the Secretary of Health and Human Services greater ability to reduce telehealth restrictions and more.

Barbershops and hair salons are long-time anchor institutions in African-American communities that have shown promise for advancing telehealth. Their partnering with libraries (a broadband anchor institution), and the Biden Administration’s enlisting of 1,000 shops and salons to help combat COVID-19, telehealth and public health in these communities could go into overdrive.

Missing their July 4 COVID-19 vaccination goals, the Biden Administration raised money to transform the shops into mini-medical centers. This success is motivating shop owners to do more. As one of the targets for $7 billion in broadband funds, libraries are idea partners that can provide broadband services, digital content, and digital and health literacy shops’ customers. 

Mike Brown manages a barbershop in Hyattsville, Maryland, and participated in the vaccination program. Brown and others owners talks with their customer about how the vaccines have been proven to work. “I use my platform to advocate for truth and dispel myths,” said Mr. Brown in an Wall Street Journal article, who has also held a vaccination clinic in his shop. “I’ve gotten about 60% of my clients to get vaccinated.”

The program has opened shop owners’ eyes to the power they have to make a difference in the healthcare of their communities. It’s a logical transition from the vaccination program to hypertension screening. Urban Kutz Barbershops in Cleveland have been screening customers for 12 years, recently with telehealth assistance from the famed Cleveland Clinic’s. 

Owner Waverley Willis says “Barbers and hairdressers are part-time marriage counselors, psychiatrists, spiritual advisers, and expert listeners. So many customers listen to our medical advice.” He has made a noticeable impact on many of his customers’ healthy eating habits as well.

Think differently about broadband, public health and telehealth

On July 1, the Federal Communications Commission began a 45-day Emergency Connectivity Fund of $7.1 billion in broadband and digital technology funding to support libraries and schools. By August 13, libraries interested in grants from the program must present a proposal on how they plan to spend money for libraries laptops, hotspots, Internet services, and other resources to advance education and remote learning. 

A generous interpretation of “education“ enables libraries to serve any patrons with broadband. If libraries are situated in areas in which there are no ISP services, they can request money from ECF to build their own broadband infrastructure for unserved patrons. Unlike traditional E-rate proposals, ECF doesn’t require a competitive bid for services, meaning libraries can present a quote from the first vender they contact.

Libraries partnering with shops and healthcare organization could give shops laptops, telehealth software, and portable hotspots to provide hypertension screening and other healthcare services that are suited to their customers’ needs up to three years. Shop owners often don’t have computing devices or Internet access in their shops. Telehealth devices such as portable digital blood pressure monitors and digital scales will have to be provided separately and possibly through funds from another government agency such as Health & Human Services.

For hypertension screening, for example, shops can take customers’ blood pressures digitally. The healthcare provider takes that data through telehealth and recommends treatment when necessary or advisable. The partner likely would have established rates for their healthcare services. Shops can then decide on additional telehealth services they want to provide.

The shops could work with libraries to develop health information and interactive Web content to reduce hypertension and other medical issues through healthier living, plus the libraries can provide telehealth services beyond what the shops can do.  

Libraries and shops can also designate customers who need a laptop, hotspots and telehealth software for chronic illnesses such as severe hypertension, diabetes, heart disease, mental health treatments, and so forth. However, these devices in this scenario would need to be given out for longer periods then just a couple of weeks. For occasional medical appointments, libraries can loan out laptops and hotspots for limited times such as two or three weeks. Libraries are good at delivering digital training and literacy programs.

Why barbershops, hair salons and libraries? 

Facilitating telehealth and healthcare does have an educational element for barbershop and hair salon customers as well as for general library patrons. These health services and information help both groups of people learn more about their own health, enables them to react effectively to medical issues, and be more proactive in taking care of their health.  

The ability for shops and salons to reach and impact African-American communities is legendary. “This type of barbershop health initiative has been shown to be effective,” said Cameron Webb, a senior White House health equity adviser on the coronavirus. Willis adds, “On more than one occasion, a guy’s blood pressure would be so high we would urge him to skip the haircut and go straight to the emergency room.”

The author of this opinion is municipal broadband expert and industry analyst Craig Settles.

Libraries have years of experience introducing new technology such as broadband to underserved populations. Matt McLain, Associate Director for Community Engagement at Salt Lake County Library, said, “We’ve had a pretty good amount of success reaching Hispanic populations at their markets. We have Asian markets out here too. And our health initiatives are quite important with the church leadership in these communities.”

The healthcare and broadband gaps are real and they are deadly! So many elements of the COVID pandemic reiterates the deadliness of those gaps. According to the Centers for Disease Control, of the data collected as of June 14 nearly two-thirds of people who got at least one dose of the vaccine were White. Only 9% were African-Americans. 14 million urban household cannot get any broadband, without which you cannot get telehealth, and 75% are Black or other people of color. 

There may never be as many federal broadband and health-related grant programs as we are seeing now. Partnership potential between libraries and haircare shops are many. Will public health practitioners and advocates, broadband builders, and community leaders step up?

Craig Settles conducts needs analyses with community stakeholders who want broadband networks to improve economic development, healthcare, education and local government. He hosts the radio talk show Gigabit Nation, and is Director of Communities United for Broadband, a national grass roots effort to assist communities launching their networks. He recently created a guide to help librarians uncover patrons’ healthcare needs, create community health milestones and effectively market telehealth. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

The WGA launched its Western Prosperity Roundtable to work on policies such as telehealth and other technologies that have the potential to connect unserved and underserved communities.

While telehealth technologies have been gaining traction for some time, the past year led to a tremendous increase in usage. David Pryor, regional vice president and medical director for Anthem Inc., said that 2020 saw 80 times more utilization of telehealth than the year prior.

With the help of innovation, health centers were able to pivot from in-person care to digital. Digital kiosks have been implemented in states such as California to help improve specialty care and decrease language barriers. These kiosks give patients access to cameras put them in touch with healthcare professionals for important services including mental health.

Empirical experiences

In one experience that Pryor shared from a frontline women’s health clinic in California, a deaf patient came in for an exam and the clinic was able to utilize the video feature with a sign language interpreter on the digital kiosk. “The patient started to cry because she [had] never had such a caring visit,” Pryor said.

Technology advancement has created opportunities for those that previously were overlooked, including rural communities that were forced to commute long distances to receive healthcare and urban centers that lacked options.

The WGA aimed for the panel to push state legislators to continue increasing healthcare access for their constituents through digitalization.

Some states have established their ongoing commitment to telehealth already. In a statement released in August 2020, the Governors of Colorado, Nevada, Oregon and Washington shared their goals to support telehealth services for residents of their states. “Telehealth is here to stay.” they wrote. “We will have individual state-driven approaches to implementing telehealth policies, but our work will be guided by seven overarching principles: access, confidentiality, equity, standard of care, stewardship, patient choice, and payment/reimbursement.”

Over the course of the pandemic, Congress has created and helped fund several programs, many of which focus on telehealth, programs to help accelerate broadband deployment across the country in efforts to connect minority communities, Tribal lands, and other qualifying households.

Recently, as the business world scrambled to implement, support, learn and be productive in a remote existence, established work-from-home companies were left unscathed. Here are seven reasons why I think working from home might be here to stay.

1.   Vast employee pool /job opportunities

Sometimes a company’s needs don’t match the talent available. When a company does not rely on a physical space to house employees, these employees can come from anywhere in the world. This selection allows businesses to choose the perfect match for their needs. It also provides job seekers a wider variety of positions to choose from, making the possibility of finding their ideal career much greater.

2.   Flexibility

“Building, growing and caretaking for a family should be seen as a positive thing. Getting sick should not mean losing your job and health insurance. We have to remember where our priorities and values are,” says Miller. Employers who run remote businesses like Miller know most families don’t fit the confines of a 9 to 5 job schedule. Remote working allows employees and employers to work any time during the day. With no clocking in and no calling in sick, the work gets done with less fuss and stress. Additionally, the flexibility of working-from-home makes scheduling appointments, school transports and school visits easier with no lost work time.

3.   Childcare

Working from home still requires some undivided attention, but those who work this way have found that their childcare issues are much easier to deal with. There’s no rushing to drop off and running late when ‘meltdowns” occur. Some remote workers still take children to daycare, but the trip is more leisurely when rushing to work afterward is taken out of the equation.

4.   Eliminating the commute

For some people, the commute to work takes hours out of their day. Eliminating this factor is beneficial on several levels, not just putting quality time back into your day. No commute saves money on fuel and saves wear and tear on your vehicle. For employers, the hassle of people being late, missing punches or being upset after a miserable commute is eliminated.

5.   Diversity and inclusion

Having the capability to hire from anywhere allows much greater diversity. In this case, diversity refers to race and culture and includes factors such as experience, education and perspective. A diverse workforce can approach a concept or problem from all angles and arrive at the best solution. Additionally, employees who might be introverts or suffer from social anxiety have the opportunity to be part of a team and utilize their expertise without the stress of being in a physical workspace.

6.   Casual atmosphere

People might joke around about staying in their sweat pants all day and not taking a shower, but you must admit that this situation is a very welcome option some days. Not having to worry about a dress code or uniforms saves everyone money and time. The casual atmosphere seems to appeal to many people who love the option to be relaxed and comfortable while they work.

7.   No brick and mortar expenses

Some work-from-home businesses have a home-based office space that they use only for special projects or occasional meetings. With this type of limited use, companies can save significantly. However, with modern technology, having this space is not necessary for most remote companies. Employers with a 100 percent remote workforce get an even bigger break because they have zero office space expenses. There are no rent or mortgage payments. No electric or water bills. No office furniture — none of the regular costs a brick and mortar office space entails. These savings increase profitability and allow the company to pay employees competitive salaries and provide attractive benefits. These savings also re-route funding to allow for the best and most current software and other technology expenses.

While everyone is glad to see most pandemic-created effects disappear forever, one might be here to stay. Remote work — a troubling wrench in daily operations for many companies a year ago — has most likely become standard operations for many.

For companies like TempDev, work during the pandemic was unscathed because we had already embraced the advantages of remote operations. And now that the rough patches are a distant memory for the others, more companies can continue working remotely well into the future.

Laura Miller is the Founder and CEO of TempDev, a company of healthcare information technology consultants nationwide who specialize in NextGen EPM and EHR and development. She combines a technical background and business savvy to create holistic and sustainable solutions positive financial and operational impacts.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

George Kramb and Patrick Frank said they saw these experiences on a consistent basis – Kramb as a healthcare worker and Frank in the experience of his mother who had a life-threatening surgical complication that could have been avoided had she been educated about her options.

In response to these experiences, Kramb and Frank created PatientPartner, a digital service that connects patients with former patients who have already had a surgery and can be a friend to talk to before and after the surgery.

In an interview with Broadband Breakfast, the co-founders said using algorithms based on a relatability matrix, patients are connected with those who are most similar to them to form the best possible bond during their surgical journey. PatientPartner said its patients felt 70 percent more prepared for surgery by having a PatientPartner to talk to beforehand, and that 65 percent of patients had an increase in procedure satisfaction.

The company is only about three years old and partners with hospitals and doctors to expand its network. The company has thousands of users spread across southern California where it started, and has expanded to major cities including Phoenix, Arizona, Dallas, Texas, and Las Vegas.

The co-founders shared how the Covid-19 pandemic affected their company. The healthcare industry moves incredibly slow when it comes to adopting new technology. But the pandemic “instantaneously changed” healthcare providers and saw rapid acceptance of their PatientPartner platform.

Digital solutions like PatientPartner connected doctors with patients who were connected in real-time with former patients to qualm their fears about surgery in ways that haven’t been done before.

To address privacy problems, Kramb maintained that every patient who signs up to be a PatientPartner for someone planning to have surgery, is thoroughly vetted. Not anyone can be a PatientPartner, and last names are not disclosed to protect privacy and thwart bad actors.

Expense for the service is not a barrier either, as neither the patient nor the partner are charged for signing up and joining PatientPartner.

“Healthcare is a very vulnerable subject,” Frank said. It is a scary process for many, and people want a more intimate experience that has more emotion rather than purely an operational perspective—something that only a doctor could give when preparing for surgery.

“Government too, can be adaptable and flexible,” said Heidi Norman, acting director of innovation and performance for the City of Pittsburgh, Pennsylvania. Asked by Dell innovation officer Tony Encinias what allowed Norman to embrace remote working during the past year, she said having relationships with tech companies like Dell helped keep Pittsburgh connected with computers, hotspots, and Wi-Fi routers when in-person work was not an option.

The town hall, which heard about experiences during the first full year with Covid, was hosted by Route Fifty, a digital news publication from Government Executive Media Group, which also publishes Government Executive magazine, GovExec, Nextgov and Defense One.

Pittsburgh had to adapt and move fast and focus on getting eligible people to work remotely and, with that, more digital software was a priority. The city had to ensure its plans were executed and communicated clearly between its staff and city residents. And to accomplish that, proper videoconferencing technology was needed. 200 city employees were able to work from home in less than 2 weeks on new Dell laptops.

Pittsburgh’s government was able to prove it can do things in new and better ways, Norman said, as it had no other choice but to increase its remote working ability. As the pandemic was emerging, much of the city staff had not worked with many of the technologies needed to work remotely, she added. Staff needed to be trained on new videoconferencing technology and learn how to set up home offices as they began working from home.

Ed Zuercher, city manager of Phoenix, Arizona, said during the event that the pandemic should create long-term “systems” to address its effects rather than bring about temporary “responses.” The city has since been able to maintain its pandemic-driven response by partnering with Dell and turned it into a system that now has plans to keep its staff with the right skills to continue being able to serve its residents.

Pittsburgh also plans to stabilize its foundational IT structure into the cloud and to establish a new wide area fiber network called NetPGH, Norman said.

Ateev Mehrotra said at the House Energy and Commerce Committee studying the future of telehealth that new technologies have allowed many Americans to get healthcare from home. But with its expansion, and its growing popularity, health care policies will also need to keep pace – and there may be significant adaptation costs and security enhancements that will need be made, he said.

One security concern is evident in existing telephone scams, which are increasing. If a prospective patient doesn’t have adequate internet at home to video chat with their physician and require a phone, they are opening themselves up to potentially being scammed or worse, being given bad medical advice.

Similarly, other witnesses present at the hearing addressed health care providers’ concerns about pricing, security, and lack of universal access to adequate broadband as the limiting factors of telehealth, especially to rural communities and underserved intercity areas.

The increasing popularity of seeing a doctor virtually on your device, compared to in person, has elevated these concerns. Now, private insurers and governments are concerned about the sustainability of the required increase in health care spending.

Mehrotra outlined that health plans would also need to be updated to reflect the technological differences, including having audio-only appointments, and align with existing plans that see patients go in person.

The long-term solution is for health care providers to invest in access to video visits to all Americans for good. Mehrotra said he advocates for telemedicine visits to be charged at a lower rate than in-person visits. In the longer-term, telemedicine visits have a lower overhead per visit, he said. The payment should reflect those lower costs, which may open up competition for customers and even lower costs.

New tech devices and programs have offered many solutions to help solve some of our struggles during this pandemic and raise our spirts.

The pandemic has also highlighted how technology supports consumers who are homebound or living distant from essential services.  In a post-pandemic environment, we can already predict that many consumers, particularly older adults, will continue to rely on many tech services they have adopted during COVID-19.  Services such as online shopping and telehealth have been particularly indispensable during this era of stay-at-home orders, social distancing and quarantine.

The benefits of telehealth options for all consumers have been demonstrated during this pandemic. Telehealth has replaced many routine doctor’s visits, has been used for setting-up COVID testing appointments, and conducting all too critical mental health sessions during periods of isolation. It has also served to keep medical workers safe during the pandemic.

According to a Center for Disease Control report, there was a “154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019….”

During the emergence of COVID-19, both a majority of doctor’s offices were closed, and their patients were staying in their homes.  Options for medical appointments were limited to a telehealth visit only, and while most medical offices reopened with safety protocols in place, many consumers opted to continue with telehealth medical appointments.

The reduction of red tape and the number of doctors who quickly adapted to virtual services was one of the greatest developments of 2020; however, only those who have adequate access to broadband internet are able to take advantage of this tool, leaving out the unconnected population.

As we contemplate permanent integration of virtual care into our medical health system, we must acknowledge that consumer demand for telehealth requires access to ubiquitous high-speed broadband. In 2021, policymakers need to take aggressive steps to deliver broadband to those who do not have access, or who are unable to afford the service.

The $900 billion-dollar COVID Relief package approved by Congress in the final days of 2020 provides $7 billion to increase access to broadband. In addition, Telehealth expansion is included within the broadband funding priorities. The package more broadly includes overall support for these initiatives, with funding for:

• Expanding telehealth access to mental health services for Medicare patients
• Closing rural telehealth gaps to provide increased funding to the Health and Human Services agency’s Health Resources and Service Administrations pilot project for Telehealth Centers of Excellence, to access broadband capacity available to rural health providers and patient communities
• The Federal Communications Commission to support the efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services.

The FCC has made a broad commitment to telehealth programs, initially under the leadership of Chairman Ajit Pai, and now in the most capable hands of Acting Chairwoman Jessica Rosenworcel. The Chairwoman recently visited the Washington, D.C., Whitman-Walker Clinic, which provides community-based health and wellness services specializing in LGBTQ and HIV care.

Rosenworcel said: “Through expanded and affordable access to broadband for all, organizations like Whitman-Walker and clinics around the country can continue to grow their telehealth efforts to support their communities.”

The Acting Chair is committed to closing the digital divide and sees access to telehealth care services—especially for underserved and marginalized communities—as a top priority. The FCC has initiated a number of COVID-19 Telehealth Programs and the Connected Care Pilot Program to focus on implementing innovative telehealth initiatives.

Telehealth has met the demand of health care management during the pandemic and has become particularly essential for older adults unable to leave their homes for medical visits.  It is vital that programs and policies supporting this technology continue to be a significant priority. In addition, access and affordability of high-speed broadband must be ubiquitous and affordable for all.

Debra Berlyn is executive director of the Project to Get Older Adults onLine (Project GOAL), and president of Consumer Policy Solutions, a firm centered on developing public policies addressing the interests of consumers and the marketplace. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC. 

Rosenworcel acknowledged that more needs to be done to connect Americans in both urban and rural areas, and that telehealth strategies are often a lifeline for areas that lack significant healthcare infrastructure, “Telehealth can help bridge the gap,” she said, “Problems can be addressed quickly, before they prove life threatening.”

This is true under normal circumstances, but the COVID-19 Pandemic “catapulted” telehealth forward. She stated that to better address the growing demand for telehealth resources, the FCC would remain committed to its goal of expanding affordable broadband access, particularly to low-income and veteran patients.

Roseworcel also emphasized that the need to provide telehealth for marginalized communities and otherwise unspecified communities that have been historically underserved was a top priority for the FCC.

The FCC has implemented several plans designed to address these concerns, and support telehealth initiatives around the country. One such initiative is the Rural Health Care Program. In 2020, the FCC announced that it would provide an additional $197.98 million to the program, providing a total of $802.7 million for the year.

Another critical initiative the FCC is using to achieve these goals is the Connected Care Pilot Program, which, among other things, emphasizes providing relief to veterans and low-income Americans. This program is now operational in 11 states with over 150 treatment sites.

The Connect2HealthFCC Task Force is continuing to engage in data collection and analysis, through initiatives such as Mapping Broadband in America, to determine which regions and communities are most at risk during the COVID-19 pandemic, and how their access to reliable internet could impact them.

Another one of the task force’s endeavors is the Broadband and Cancer Collaboration for Appalachia, a partnership between the National Cancer Institute, the FCC, and other stakeholders I the region, designed to identify how broadband connectivity can impact rural cancer patients living in underserved areas.

In addition to the initiatives they are working on, the FCC has also proposed an $18.7 million fine for those who violate the FCC’s competitive bidding rules outlined in the Rural Health Care Program. The fine would also apply to those who use or attempt to use fraudulent or misleading documentation to seek funding from the Universal Service Fund.

These programs are a part of those emphasized by Rosenworcel in her efforts to close the digital divide between Americans, not just during the COVID-19 Pandemic, but even after the crisis has subsided.

The pandemic has played a significant role in how state governments function, particularly in regard to the need to convene in person.

Police reform has become a major priority, as the use of excessive force and chokeholds has been called into question.

Additionally, questions linger on determining what should constitute a “no knock” warrant or how much immunity police officers should be granted. The questions even impact the type of body-cams worn by police, and the types of data that need to be collected.

Confusion about Census Bureau data collection

Further, confusion and anger linger around the 2020 Census delays, as impacted by the pandemic and by the Trump administration’s efforts to limit the counting of persons who live in the United States but lack citizenship status. These delays may impact state  redistricting efforts, which could postpone primaries.

Immigration was also discussed. “Given lack of federal activity, states have moved to their own immigration framework, and we support pathway to citizenship and comprehensive immigration reform,” said Susan Parnas Frederick, senior federal affairs counsel at the National Conference of State Legislatures.

In combatting the pandemic, states need federal funding to improve vaccine funding and to close state revenue gaps for unemployment insurance funds.

On redistricting, 44 states held 5,876 legislative races in 2020.

Only two chambers changed party control. The majority of chambers are Republican: Democrats have not held a majority of seats in legislatures since 2010.

Thus far in state legislatures, 1,946 bills have been introduced in 37 states about election issues.

Mail in and absentee ballot voting was the highest at 447 bills introduced, followed by bills related to voter registration at 313, and 139 related bills on counting ballots, recounts, and audits. Other bills focus on the impact of cybersecurity, disasters, and emergencies on elections. Some were also related to the electoral college and the national popular vote.

At the Consumer Technology Association’s annual Consumer Electronics Show on January 12, David Kirkpatrick, editor-in-chief of Techonomy Media, facilitated a robust discussion with a panel of experts on the telehealth lessons learned from 2020 and the future of digital health.

“As a country, we were unprepared,” said Lee Schwamm, vice president of Digital Health Virtual Care at Mass General Brigham. “Internet service providers were not prepared for the increased internet load, and video teleconferencing providers were not prepared for the spike in demand.”

The panelists agreed that while many things were learned from the pandemic throughout 2020, the main thing that was brought to light is that people need quality health care at affordable prices.

According to panelists, the costs associated with health care are a major roadblock to digitizing the health system, as payers may wonder what the true value of the health services they are paying for is.

These payers include employers who may seek to save money on health expenses when trying to find the best providers for their employees. If employers can hold digital health companies to a high standard, their employees can enjoy lower health care costs, thus saving money for the employer’s bottom line.

Deneen Vojta, executive vice president at United Health Group, further critiqued COVID-19 responses in 2020, saying America’s health care system focuses too heavily on the end stage of diseases and health ailments. Vojta said directing resources towards early health care treatment in the form of signal detection and prevention is severely under cared for.

The future of digital health care

Looking forward, “there is a great challenge to find the best and safest ways to bring employees back to school and students back to work,” said Vivian Lee, president of platforms at Verily.

Lee discussed ways to leverage technology to bring employees and students back to traditional, in-person settings, such as building digitalized back-to-work and school programs, getting COVID-19 testing to all, and developing health apps, which can aid research in numerous ways, as many have access to smartphones and computer devices.

Inder Singh, CEO of Kinsa, further voiced optimism in telemedicine applications and tools. When the next pandemic hits, people must be prepared to combat it not just physically, but digitally, he said.

Kinsa makes a connected thermometer on smart devices via an app that communicates with others if the user has early signs of sickness. Kinsa was able to predict flu incidents months out on a city-to-city basis thanks to the nearly 2 million user downloads it had on smart devices.

Singh reminded that many underserved communities still lack access to broadband, noting that smartphones are more commonly accessible to low-income Americans.

In addition to getting the current COVID-19 pandemic under control, Lee believes mental well-being should be a priority of digital health initiatives going forward. By having access to mental telehealth services, patients can see health providers much faster and easier than the traditional means of physically traveling to a practice or clinic.

Lee warned that not all telehealth care is the same, as intense discussions over fee-per-service or value-based health care continue to rage on. Lee said she believes that health providers should be paid only when “delivering better health outcomes resulting in the patient’s improvement, rather than utilizing a fee-per-service” based system.

Health economist and blogger Jane Sarasohn-Kahn used a session on “Telemedicine Skyrockets to Mainstream” to declare that broadband is a social determinant of health, and that the home has become a health hub.

Iris Berman, vice president of telehealth services at Northwell Health in New York said that telehealth is a means for patients to get care immediately, especially when rush hour traffic would disrupt travel times to and from places of care. But he voiced concern that telehealth may not grow without better broadband.

She said it was a myth that broadband is better in cities than in rural areas. Indeed, there are areas of New York City with very poor broadband availability. This hinders telemedicine, as well as making it more difficult to work and participate in educational activities.

Jason Gorevic, CEO of Teladoc Health, said the trend for telehealth has gone from consumers asking, “is telehealth right for me?” to “I prefer telehealth as my first choice.”

He company has experienced substantial growth since its founded in 2002. More than 10 million telehealth visits are expected during the 2021 year, and he credited that to virtual care. Bringing health care to patients allows the same quality care to anyone regardless of where they live. Virtual health is a great equalizer, allows patients the same quality care regardless of where they live. They also are freed from “needing to make a pilgrimage to the health care provider,” he added.

Nurx CEO Varsha Rao said the COVID-19 pandemic increased medical requests and yet, with colleges closing down and going remote, campus health services also closed, forcing students to adopt telehealth practices. Nurx set up college hub health service centers on college campuses to provide support for closed health centers.

She said that by the end of next year, telehealth will become the first-choice option for millennials and members of Gen Z, ahead of being a second or third choice.

“Consumers were only sort of ready, and we as providers were definitely not ready,” said Dr. Roberta Schwartz, executive vice president and chief innovation officer at Houston Methodist Hospital, during a virtual webinar, which aired as part of Broadband Communities 2020 Virtual Summit in September.

During the event, a panel of broadband infrastructure and telehealth professionals moderated by John Windhausen, executive director of the Schools, Health and Libraries Broadband Coalition, discussed the amplified use of telehealth services and ways to overcome limitations. Those limits have become apparent in attempts to connect hospitals, clinics, and consumers at home.

“Telehealth begins with connectivity,” said Matt McCullough, associate director of the Utah Telehealth Network, a service which links patients to health care providers by using leading edge telecommunications technology. “Our goal is to get reliable networks into rural communities to make sure clinics have accurate bandwidth.”

According to McCullough, while most education sites have access to Gigabit connections, healthcare sites experience much more problems with bandwidth and variances in internet speeds.

While some healthcare facilities have 100 Megabit per second broadband speeds, “small rural clinics rely on 25 [Megabits per second] Mbps connections.” Further, at “clinics located on Najavo reservations, even accessing a 25 Mbps connection is difficult,” said McCullough.

Attempting to contest telehealth limitations, Robert Wack, city council president of Westminster, Maryland, who led the planning and construction of Westminster Fiber Network, said he hopes the fiber infrastructure benefits users within the community.  Wack reported that the city has been successfully employing remote patient monitoring systems, to reduce the amount of times that patients have to return to hospitals.

While the panel detailed some success, Schwartz projected that there is much more on the horizon when it comes to improving telehealth accessibility around the country.

Schwartz called for utilizing artificial intelligence to improve delivery of service, and more tedious processes, like workflow, documentation, and billing.

McCullough recommended integrating telehealth into schools to ease the burden on school nurses, who often have to travel to many different school districts a day to serve students.

“The pandemic has caused people to consider what the right mix of services are for them. We’re now seeing a more user-centered design.” Andrew Altorfer, CEO of CirrusMD.

According to Nathan Treloar, president of Orbita “Telehealthcare systems are taking center stage.” Mobile devices allow for a rich database that can be leveraged to improve user experience.

Josh Garner, CEO of Becklar, said that “90 percent of the 600 alarms we might receive daily are false. Using AI technology, we can weed out the gunk.”

AI technology has also been used to perform wellness checks.

“One third of users had behavioral and physical needs,” said Altorfer, and ”sentiment analysis has become adept at identifying suicidal patients.” AI technology has advanced to be able to analyze biomarkers indicating depression and difficulty breathing.

Healthcare workers have also benefitted from a mobile approach. These technologies act as a “triage center,” said Garner, speeding care for patients.

“Data provided by 5G is a godsend to first responders,” said Tad Reynes, regional vice president of healthcare solutions at AT&T. “EMS workers can send real time images to those waiting in the ER,” drastically decreasing treatment time once patients arrive.”

Amazon has participated in the healthcare surge as well.

Speaking at the virtual conference of the National Association of Telecommunications Officers and Advisors on “Leveraging Smart Communities Beyond a Crisis” on Monday, these cities shared stories about rising above technological challenges presented by the coronavirus pandemic.

Michael Sherwood, chief innovation officer for Las Vegas

In Las Vegas, for example, city officials described using Citizen Broadband Radio Service spectrum for public Wi-Fi infrastructure across the city. Chief Innovation Officer Michael Sherwood, said that CBRS is “a mix of Wi-Fi and a mix of cellular wrapped into each other.”

As in Las Vegas, Boston’s Mike Lynch, director of broadband and cable for the city, explained how Boston has worked closely with its network providers to bridge the digital divide. He said this was manifest in lower broadband prices from Comcast, Verizon, and RGN Boston.

He also said the city was working to create more hotspots as well as digital literacy programs.

Since 2014, New Orleans’ broadband initiative has collected data on populations that need it, which has helped the city with targeted community projects.

Kimberly LaGrue, the city’s chief information officer, said that broadband has helped with workforce development programs, getting fiber connections to public housing and churches, hosting free device repair clinics, and providing additional educational opportunities in the community.

Doug McCollough, chief information officer for Dublin, Ohio

Dublin, Ohio, has done similar activities. “When COVID hit, the separation between private and public sectors changed,” said Doug McCollough, chief information officer.“Schools and communities have had to work together to provide broadband everyone.”

Preexisting broadband infrastructure and mapping has helped communities respond to COVID-19. Dublin’s fiber network, installed in 1996, has been invaluable, said McCollough. For Cobb County, Georgia,  use of geographic information systems enabled them to use data effectively in responding to the coronavirus pandemic.

The panel agreed that the internet is a human right, and New Orleans and Dublin officials were the most vocal about this.

“Fiber broadband is paramount,” said LaGrue. “Any supportive plan for a city has to provide municipal fiber. It is the only way to bridge the digital divide.”

Boston’s Lynch agreed that “all of our citizens to be connected,” but acknowledged it was problematic to make broadband a utility.

“It should have been back in 1996” when the Telecom Act was passed, he said. “We are faced with the dilemma of taking the responsibility upon up to provide services to those who cannot afford them. We can’t make it a utility but we have to find the dollars to make it affordable.”

According to panelists on two Tuesday webinars, which were both part of the week-long Connected Health Summit sponsored by Parks Associates, the crisis has exposed just how much work remains to be done to integrate digital health into the fabric of healthcare access and delivery.

“The digital and connectivity foundations laid over the last decade have been put to the test,” said Tori Ames, manager of the center for telehealth at Cincinnati Children’s Hospital, detailing the stress that many healthcare providers were put under at the beginning of the pandemic.

“Many of us had to work around the clock to meet patient’s needs,” said Ames, saying the pediatric hospital’s telehealth team remained the same size, as telehealth visits jumped from 5,000 to 30,000 sessions per month.

The pandemic rendered telehealth a necessity, which brought about the rapid development of software and technology. Ames’ team implemented over 60 new telehealth programs and onboarded over 1,000 telehealth accounts for providers, in just a few short weeks.

Prior to the pandemic, licensure limitations and reimbursement barriers restricted the growth of the telehealth market. As insurance companies have removed barriers to telehealth services, the market has grown exponentially.

“Tools have expanded and digital platforms have improved,” said Ames, noting this includes developments in symptom checkers, remote patient monitoring, solutions for seniors, and online fitness and wellness platforms.

As the market expands, Ames said that individuals can expect telehealth to trend towards consumerism and advanced interoperability.

Today, 35 percent of households own at least one telehealth device or product and between Q1 2019 and Q1 2020, intention to purchase a smart watch rose from 13 to 20 percent of U.S. households with broadband access.

A slew of symptom checkers have risen to compete in the marketplace, including Tyto Care, founded by Dedi Gilad, which enables remote physical exams, checking for COVID-19 symptoms, anytime and anywhere.

There have also been notable developments in digital health monitoring products. For example, Greg Lillegard, chief operating officer of A&D Medical, created a blood pressure monitoring device, which detects abnormal heart rhythms.

When asked how to improve telehealth technology moving forward, Ames answered that “it is crucial to assess the workflow, processes, and technology that were implemented during the rapid scaling period.”

Ames noted that questions remain about how massive amounts of potentially useful data, generated by telehealth, can be better implemented.

She had been homeless before and struggled to commute long distances for treatments. But because of her failure to attend several appointments, her previous doctors stopped seeing her.

Years later, in a bid to get clean, she moved to Estes Park, Colorado, and began attending a treatment program at Salud Family Health Center.

“It’s beautiful. It gets me away from the hustle and bustle of everything,” Sanders told KUNC, a radio station in Greeley, Colorado. “Estes Park is like a little bubble – a little protective bubble, and I like it.”

Then, because of the coronavirus, Salud began limiting in-person treatments.

“I didn’t know what we were going to do. I had no clue,” she said.

Sanders’ story is illustrative of the experiences of millions of Americans. And while America is racing to provide increasingly vital telehealth services universally during the coronavirus, there are still significant challenges with conducting telemedicine.

Fixes for permitting telemedicine during the coronavirus

In early March, Congress passed legislation that would temporarily allow patients in need to access telehealth services across state lines, as well as other key expansions.

The law, including as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6074, allows psychologists to treat patients from their homes, permits telehealth for Medicare recipients across the country and not just in underserved rural areas, and also allows nursing home patients to receive services via telehealth.

In August, President Donald Trump signed an executive order would allow individuals to pay for telehealth with Medicare in certain circumstances. It also directs task forces from the Departments of Agriculture and Health and Human Services to be created, and it calls for one of the FCC’s existing task forces to focus on telehealth.

The executive order was widely praised. At the Republican National Convention, Registered Nurse Amy Ford went so far as to say that Trump’s Executive Order would save lives.

“As a healthcare professional, I can tell you without hesitation, Donald Trump’s quick action and leadership saved thousands of lives during COVID-19,” she said. “And the benefits of that response extend far beyond coronavirus.”

The American Telehealth Association also praised the move, saying that it was a necessary step “to ensure individuals receive the care they need during this national health emergency.”

However, some worry that these expansions could leave millions unconnected when the virus is over.

“There is more work that needs to be done, on both the federal and state levels, to cement these gains and make permanent the waivers put in place in response to COVID-19,” said ATA CEO Ann Mond Johnson.

She said that while Trump’s Executive Order was a step in the right direction, continued work is needed to combat the coronavirus’s potential to harm vulnerable populations.

“The stresses on our healthcare system were well-documented prior to the pandemic – including crippling provider shortages, escalating costs, and an aging population – and will only be exacerbated as our nation begins to recover from this health crisis,” she said.

But Frank Micciche, vice president of public policy and external relations at the National Committee for Quality Assurance, thinks that telehealth legislation will continue to advance out of necessity.

“I think the Administration and even the private sector would have a really hard time going back to pre-COVID, Just because people on all ends of the system, providers, patients, you name it, have appreciated a lot of the benefits,” he said.

The future of telehealth after the pandemic ends

Companies like Teladoc, which partners with medical practitioners across a variety of disciplines, have become essential arbiters for providers historically unable to offer services across state lines.

A representative for Orlando Health Network said that they have advanced their remote services substantially during the coronavirus thanks to Teladoc.

“We deployed a dedicated COVID-19 screening and questions service on our Virtual Visit platform,” they said. “This was available to the community, as well as offered in partnership with several Central Florida employers to give patients 24/7 access to an Orlando Health physician for their questions about COVID-19.  We have done over 60,000 virtual visits during COVID-19.”

The representative said Orlando Health is positive about the future of telehealth.

“We believe that consumer demand will drive the legislative environment and we are optimistic that coverage for telehealth services is here to stay,” they said.

However, while federal funding and legislative proposals are plenty, the future of telehealth is uncertain. It is unclear which, if any, broadband and telehealth stimulus bills will pass, and a unified national telehealth expansion effort down to the local level is unlikely.

Sanders said that the ease of access that remote health has afforded her will make it difficult to return to in-person appointments if inter-state telehealth provisions are not agreed upon.

“I just step to the back at work for about 15-20 minutes and then I’m back right at work,” she said. “I don’t want to have to go back to having to go in person.”

The virtual discussion featured a panel of experts from Michigan State University and Baptist Health who spoke on the past, present, and future of telemedicine practices and technology.

“Digital health continues to change the industry,” said Sarantis, saying the business has undergone a paradigm shift, in that consumers are now requesting telehealth.

“Pre-pandemic there were a lot of barriers to patients accessing telehealth,” noted Bree Holtz, director of the Health and Risk Communication Master’s program at MSU.

But, health insurance providers began covering and reimbursing patients for telehealth appointments throughout the pandemic. Panelists said they expect barriers which previously existed to remain down.

Holtz said she expects digital health practices to become the new standard.

A study conducted by Holtz found that 80 percent of people over 30 years old responded that they are more likely to use telemedicine going forward, while all age groups reported being equally satisfied with telemedicine experiences.

“The more satisfied they are, the more likely they’re going to do it in the future,” said Holtz.

The panelists discussed the emerging uses of telemedicine, noting digital innovations promise to shape the industry indefinitely.

According to the panelists, telehealth is the field that may experience the most changes in the 5G revolution.

The high latency capabilities of 5G will allow for the quick and reliable transport of huge data files of medical imagery, which can generate up to 1 gigabyte of information per patient study.

Remote patient monitoring wearable devices will improve patient outcomes by monitoring physical health and equipping providers with data they otherwise may not have access to.

The panelists noted that challenges remain, including issues with patients’ digital literacy.

“Patient education is something we overlooked initially,” said Sarantis.

Sarantis reported practices utilized by Baptist Health Systems included walkthrough tutorial videos and training providers with digital interpersonal skills.

“There’s no platform. What policy is the president pushing? What is his second term agenda?” questioned a reporter for The Hill.

The party leaders said that Trump is offering an extension of his platform from four years ago.

Trump’s 2020 platform is “more of the same,” said Rep. Jim Jordan, R-Ohio. “Trump has actually done what he said he would do.”

This, he said, would be a key message iterated throughout the convention, adding that “we plan to focus on the American people.”

“Trump has delivered for the American people and that’s what I’ll talk about,” said Jordan, who spoke during Monday night’s program.

The representatives said they plan to focus the convention on Trump’s presidential performance prior to the arrival of COVID-19.

“If you liked what you were seeing before February of this year, you’re going to like what he’s doing,” said Sen. Roy Blunt, R-Missouri, adding that “no one anticipated the impact of the COVID-19 virus.”

Jason Miller, Trump’s campaign senior advisor, said that a key differential between Biden’s campaign and Trump’s campaign is that Trump’s campaign will “push to eradicate COVID-19.”

“Last week people tried to put up divides,” said Miller, calling the Democratic National Convention a festival of grievances.

“There was no upbeat optimistic tone during the DNC,” said Miller, saying the RNC “will be about what unites us as Americans.”

While the political insiders claimed Trump’s campaign would offer a push to eliminate COVID-19, they maintained some policy ideas that may further the spread of the disease. For example, Jordan said that “in person voting is the safest way to vote.”

In-person voting may, however, contribute to the spread of COVID-19. But Jordan said, “2e can do it in a safe fashion and we can do it in person.”

Jones also called for opening businesses up to “let the American economy take off.”

This moment of heightened loneliness and mental health crises underscores the innate need humans have to connect with one another.

To explore the present and future of social relations, the Aspen Institute held a webinar on Thursday entitled “Virtually Alone: The Future of Human Connectivity,” in which panelists came to the conclusion that technology both helps and hinders the ability to connect and maintain meaningful relationships.

Many users who logged onto Instagram this week were met with a promotional banner leading to mental health resources.

The feature is one of many that Instagram has implemented after a 2017 survey by Britain’s Royal Society for Public Health ranked it as the worst social media network for mental health and wellbeing.

However, efforts like these may not be enough to counter the social health crisis being brought about by the pandemic, panelists said, and if Instagram’s top priority is truly user wellbeing, it certainly has its work cut out for it.

“The loneliest demographics are millennials,” said Dan Buettner, journalist, producer, and National Geographic Fellow, adding that loneliness “peaked after 2011, when handheld devices became ubiquitous.”

“It’s a correlation,” he noted.

Research conducted by Robin Hewings, director of campaigns, policy and research at the Campaign to End Loneliness, found that having access to technology eased loneliness during COVID-19, as individuals were able to mitigate feelings of loneliness by utilizing applications such as video calls.

“Digital tools allow you to find your people wherever you are, but even people who are connected can feel as though they are unheard,” said Brittney Cooper, assistant professor at Rutgers University.

Technology can both mitigate and amplify existing conditions, depending on use and application, she explained.

“In this sense, technology has combatted one part of the loneliness problem and enhanced another,” Cooper said. “Social media can be a very tough mirror.”

“Sometimes, the basis of online social connections can be unhealthy, especially when this is powered by unrighteous rage,” she continued. “We need to take a critical eye to how and why we form connections online.”

“Looking for an answer to loneliness in a gadget is misguided,” Buettner argued, although he later added that he was perhaps being too harsh on technology.

Creating safer spaces for interaction should be a priority, Hewings concluded.

Dr. Judd Hollander, associate dean of strategic health initiatives at Thomas Jefferson University, said that there are inherent limitations to telemedicine, and that virtual care is often not what people imagine.

“Telemedicine is not medicine — it’s a care delivery mechanism,” he said. “So if I’m a cardiologist, I’m delivering cardiac care. If I’m a lung specialist, a pulmonologist, I’m delivering pulmonary care… so the medical care is the same, and so it is all about workflows and operations and very little about technology.”

At the beginning of the pandemic, Hollander said, regulatory restrictions were loosened and doctors felt the need to take drastic measures.

“You didn’t need to buy an official telemedicine platform that might cost you six figures,” Hollander said. “You could just use FaceTime or something that doesn’t meet the regular security requirements with the regular consent requirements of telemedicine. But hell, this was a pandemic, this was a crisis, we needed to do something.”

Graham Mitchell, city manager of El Cajon, California, said that barriers to adoption of telemedicine, especially among the elderly, can be difficult to overcome. El Cajon has taken measures to increase use and enable the elderly to get the care they need from a safe distance, he said.

“Even I have to ask my 14-year-old son how to do a lot of things on my phone, and I’m relatively young,” Mitchell said. “We know through experience that the best way to teach a senior how to use technology is hands on… [but] during the pandemic, we can’t do that, so we are working on a series of how-to videos.”

Hollander said that there need to be regulatory guidelines on the technology that doctors can use.

“I don’t think the relaxation and using whatever toy you have around your house to deliver medical care makes sense,” he said. “…It’s better if I use an app where I come in and I sign the terms of use and say I agree with what they say. Some of the big relaxations, I think, probably should go away to keep patients safe and secure and make sure that they know what they’re getting care about.”