Telehealth: Make Sure You’re Connected, the Writing’s on the Wall

William Manzie, Telehealth Manager for Nicklaus Children’s Hospital, showed Commissioner Clyburn how hospital specialists connect with patients anywhere in the world. Photo by Federal Communications Commission [Public domain]

My son had a med-check scheduled for this morning with the pediatrician. Rather than cancel, the appointment was converted to a telephonic visit. Dr. Eric texted a link to my smartphone, I clicked it, and we connected via video chat. We didn’t have to leave the house and expose ourselves to sickness, or cancel and then try to guess at how far out we needed to reschedule. He is due for a checkup, though, so that will have to be scheduled sometime after the quarantine’s end.

This was my family’s first experience with telehealth, but I suspect it won’t be the last. With the coronavirus making all but critical in-person medical appointments unwise right now, the merits of telephonic medicine are beginning to shine. It is reasonable to suspect that the trend toward telehealth will continue, even after the pandemic has been tamped down.

In fact, it may seem that virtual meetings are the new norm, whether medical, business, or school related. But before we get ahead of ourselves, a few realities need to be recognized and discussed. Most crucial is the fact that less than 80% of American households have broadband internet access; in Appalachia, its only 72%, with some rural counties reporting less than 60%.

The reasons are varied. Poverty plays a role; many simply can’t afford the monthly expense. For others, it’s good old fashioned Luddism. My dad falls into this category; he has no internet service or even a computer, nor does he want them; in fact, he refuses to have them. My mother has a smartphone, though, and he’s been known to ask her to “look this up on the Google.” She can’t always do so, however, due to another factor contributing to the lack of internet usage in rural areas: lack of infrastructure.

In some places, cell phone towers are few and far between. At times, my mother barely has the signal strength to make a call, let alone access data.  In many remote areas there is no available traditional internet services; the only option is costly satellite-based service. Even if one can afford the pricey service, the set-up requires a clear view of the southern sky — a problem if you live deep in a holler.

Proposed government projects to bring broadband to these areas are controversial, and met with the same scorn as “Obamaphones” were. Of course, the “Obamaphone” program is actually the Reaganphone program or more accurately, the Lifeline Assistance Program.  This program was established in 1985 by the federal government which, recognizing the importance of telephone service, helped provide low-cost phone lines to needy households. My grandmother was part of the program; her phone was rotary, yellow, and wall-mounted. Her calling area was limited, but her monthly bill was low. Under the Obama Administration, the Lifeline Program was modernized and provided a basic cell phone and plan as an option for qualifying persons, in lieu of and not in addition to a landline.

Part of the reason the 2016 Lifeline Modernization Order added cell phones to the program was that the Order recognized broadband as an essential service in the same way telephone service was. The Lifeline cell phones include 3G broadband as part of the package. Of course, this is not keeping the pace with technology, and a 3G smartphone would struggle to handle the demands of our current virtual connection needs.

Schools assume that all students have some sort of computer or tablet with internet access at home. With schools closed, learning has moved online. Some are doing actual interactive classes through Zoom or other web conferencing; others just post the assignments online. My children are not allowed to bring textbooks home, so they must access the material via the internet. We’ve been doing this for three weeks; just today, a phone message went out telling parents that they could “access school wifi from school parking lots” or pick up a packet of papers at the county board office, instead of the online work. (It was as though the lack of home internet access for some kids never occurred to them except as an after-after-after thought.) Undoubtedly, for many children education is going to suffer right now.

Supplying every home with the service and equipment to access the internet is not a feasible goal. Not in the short term, any way. But chances are good that at least some of the shift to online work, school, and medicine will remain even after coronavirus is a bad memory. Now that society has tried it and found it doable, it is likely here to stay in many ways. In addition to convenience and (probably) some cost savings, it has opened up a world of accessibility for disabled people, whose employers have suddenly found that yes, they can accommodate their employees’ different needs.

Getting back to telehealth: its benefits are obvious right now. While it can’t replace all face-to-face exams, a virtual visit to discuss symptoms or other issues is highly preferable to venturing out to public places where sick people tend to be. For less physical medicine such as psychiatry and therapy, it seems a no-brainer. Prior to coronavirus, though, many have been slow to embrace the idea. Medicare and Medicaid, in the not-so-distant past, wouldn’t pay for telemedicine. Some insurance carriers are still balking at it, even now. And, as already discussed, it is not readily an option for others for logistical reasons.

These barriers are not insurmountable, and we need to look toward putting systems in place to facilitate online connectivity. This does not only mean putting computers and internet access in everyone’s home. There are other solutions, such as installing telehealth “stations” at Federally Qualified Health Centers, schools, or senior centers, and increasing the availability of internet access at libraries and community centers. A broader effort to improve and expand the necessary infrastructure, such as broadband reach and cell towers, is necessary as well, and a likely first step.

In many ways, we’ve become a virtual world. Let’s prepare and adapt accordingly.