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Finding the broadband pipes for rural telemedicine

Don Fluckinger, News Director

SAN JOSE, CA -- At this year's American Telemedicine Association's annual meeting, many new topics governed the conversation, such as how remote patient care via live video streams will fit into accountable care organizations and their patient-centered medical

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homes. But an old topic -- getting rural telemedicine practitioners access to broadband pipes that will support this mode of care -- lingers on.

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Why? Because it's still an issue, despite federal initiatives to expand rural broadband access. While urban centers are enjoying the benefit of high-speed wired and wireless access supporting every use from consumer Netflix downloads to extending the access of in-demand medical subspecialists, patients living in sparsely populated states like South Dakota still have to drive hours to receive the same care their urban counterparts enjoy. Telemedicine can bridge the gap in some patient care scenarios, but only if practitioners can get the Internet connection to support it.

In the case of the Avera McKennan Hospital network serving the Dakotas, patients drive up to five or six hours each way for care, depending on the type of specialist needed. The health system reaches patients and providers in five states, some of them small critical-access facilities a hundred miles from the next facility -- and that next one might not necessarily be bigger. An acute dearth of specialists -- for example, only two colorectal surgeons and five neurosurgeons cover the whole territory -- compounds the issue of geographical distance.

Avera McKennan's Donald Kosiak Jr., M.D. said that the health system is aggressively developing telemedicine initiatives in those remote regions, which includes implementing e-ICUs -- intensive care units staffed remotely by physicians via video feed. But getting broadband access to those remote locations continues to be a sticky issue.

If I'm in San Jose, I have 4G network; if I'm in Wishek, North Dakota [population: 1002], I'm lucky to have 1G.

Donald Kosiak Jr., Medical Director, Avera eCARE

Kosiak, a practicing emergency physician and medical director of Avera eCARE, believes that in the future 4G wireless networks could potentially be the key to expanding telemedicine initiatives to the furthest outposts of Avera McKennan's patients. Using 4G, mobile devices appear to work as fast as those using wired broadband access, he said -- it's that quick. Lack of 4G coverage is the issue. "If I'm in San Jose, I have 4G network; if I'm in Wishek, North Dakota [population: 1,002], I'm lucky to have 1G," Kosiak said.

A recent Deloitte survey affirms that 4G mobile networks hold much potential for many business sectors, none more than health care. For now, Apple's iPhone, while popular among physicians and consumers alike, does not have a 4G-compatible device.

Verizon, which sells both iPhones and 4G-compatible Android phones, appears to be pushing Android devices ahead of iPhones, an interesting twist for rural health care IT decision makers desperate to get more bandwidth into their practitioners' hands: Wait on Apple, or move on with Android-based telemedicine implementations. Or, like Avera McKennan still must do with remote locations, forego wireless and patch in old-school T1 lines.

Speaking of T1 lines, Kosiak's also warming up to another solution for getting high-speed Internet to critical access hospitals and other locations requiring video-ready throughput that’s recently been discussed: Tapping into existing wired high-speed infrastructure, specifically the dedicated T1 lines already in place in small communities by banks and other businesses. Sharing such bandwidth as a community resource could also work to enable rural telemedicine and extend physicians' reach.

"We need to reach out to other industries that are leaps and bounds ahead of us in sharing data and pushing it back and forth," Kosiak said. "So maybe I can just piggyback off of existing technology that's already in rural communities -- banks, high-tech industries, big mills, big meat packing plants probably have all sorts of connectivity for data, and maybe the hospital doesn't need their own."

Kosiak sees wired high-speed networks as the solution for health care, at least for the short term. In 18-36 months, he thinks both AT&T and Verizon's 4G networks will blanket most of the country and revolutionize wireless data. But even then, 4G might fall short. When looking at a national map, "those little gaps in coverage are where I need to connect," he said.

Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.


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