Telehealth and Telemedicine – Critical Need for Rural Populations

As of April 2020, the coronavirus pandemic continues to dominate our lives and radically alter how we do business and how we interact with everyone from the pizza delivery guy, grocery store cashiers, neighbors and the healthcare system. While our healthcare system is being taxed beyond its capabilities there is more and more interest in telehealth and telemedicine, especially for rural populations where the need is critical.

What’s the Difference Between Telehealth and Telemedicine?

The two terms are often confused or used interchangeably as there continues to be some confusion around the terms. For the purposes of this blog, the difference is not particularly important, but a good working definition from the Office of the National Coordinator for Health Information Technology:

“Telehealth refers to the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.”

Wikipedia provides a little clarity as well:

“The World Health Organization uses telemedicine to describe all aspects of health care including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments.”

So, if we split up the two terms then telemedicine would deal with remote clinical diagnosis and monitoring with a healthcare professional (doctor or nurse) while telehealth would deal with a broader range of services, including remote consultation, treatment, education, care management and self-management, and this may or may not include a doctor.

We will use the broader term “telehealth” for the remainder of this blog.

Four Major Telehealth Applications/Modalities

The range of services provided by telehealth in very general terms is described by HealthIt.gov as:

• Live videoconferencing (synchronous): a two-way audiovisual link between a patient and a care provider
• Store-and-forward videoconferencing (asynchronous): transmission of a recorded health history to a health practitioner, usually a specialist.
• Remote patient monitoring (RPM): the use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.
• Mobile health (mHealth): health care and public health information provided through mobile devices. The information may include general educational information, targeted texts, and notifications about disease outbreaks.

There are many software applications and vendors that support these modalities, and many companies are enhancing current products to tailor them for healthcare needs. Microsoft, for example, offers “Teams for Healthcare” as an integrated part of its Office 365 platform. According to their website, “Teams gives care teams and healthcare professionals a secure way to communicate, coordinate patient care, and improve operational efficiencies.”

Rural Populations and Telehealth

Rural populations (approximately 60 million Americans) need telehealth the most yet are often critically underserved in terms of the broadband internet access necessary for the technology solution to work. Rural Americans tends to be sicker, older, overweight (no offense!), and significantly further away from any healthcare provider than their urban counterparts. In fact, according to the CDC, “people who live in rural areas of the United States are more likely than urban residents to die prematurely from all of the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.”

Rural America also continues to be underserved with respect to access to broadband internet. As a direct result, the coronavirus may hit rural America later and harder. The good news is that the US Government is well aware of this and the current pandemic has amplified the issue. The FCC has recently taken steps to address the rural broadband connection problem in several ways, according to InTouchHealth:

“The Connect America Fund is helping 713,000 homes and small businesses in underserved areas connect to the internet by providing equipment and installation services. The Rural Health Care Program is giving $518 million to qualifying healthcare providers to help them establish a telehealth system, including connectivity tools like routers, computers, and tablets. Lastly, a Connected Care Pilot Program was just awarded $100 million to provide low-income patients and veterans with sensors for remote patient monitoring (RPM).”

The FCC has also just recently approved $20 billion dollars to support rural broadband buildout as part of the Rural Digital Opportunity Fund.

Mobile and Temporary Clinics

Another critical asset for distributing healthcare to rural populations includes mobile and temporary clinics. A mobile clinic is typically a specialized vehicle (van, trailer, ambulance) that travels from place to place providing much-needed healthcare prevention and other basic services. A temporary clinic would be a site that is set up over several hours or days and would consist of a bit more physical infrastructure than a mobile clinic and would typically include temporary structures that would be disassembled when the clinic left town.

So the difference between the two terms is somewhat semantical but the critical point is that these clinics provide desperately needed emergency and/or preventative healthcare to populations physically removed from urban areas where healthcare access is much more plentiful and convenient.

A major similarity with these clinics is that healthcare providers will need to have access to their EHR (Electronic Health Records) and other vital applications in the cloud. Many of these telehealth applications require a sustained Internet connection, otherwise, they disconnect from the cloud server and the session dies. The healthcare practitioner then needs to re-login and do everything again. Due to the mobile nature of these clinics many of them must rely on a single cellular connection which we all know provide generally reliable coverage for our smartphones but are simply not reliable enough to count on in life-and-death situations. The wireless signal fluctuates widely over short time and distance scales, and with multiple users on the same connection bandwidth and cross traffic can become problematic.

Broadband Bonding & SD-WAN Solutions for Healthcare

So, mobile and temporary clinics start off way behind the curve due to lack of readily available and highly reliable broadband internet. Running an entire healthcare van or ambulance or entire clinic off of a single cellular modem is a terrible solution, but oftentimes it’s the only solution available. And having a second (or multiple) cellular modem(s) in operation helps the situation, but each and every internet session must still rely on a single link for communication.

A great solution is using SD-WAN with broadband bonding to intelligently aggregate multiple cellular cards from the same or different ISPs resulting in a single high-bandwidth, high-reliability, highly optimized broadband pipe.

And Mushroom Networks has been doing this for years.

Mission-critical healthcare applications rely on high-performance Internet connectivity. Hospitals and other healthcare offices leverage Mushroom Networks’ SD-WAN to support their mission-critical applications. Mobile and temporary clinics empower their caregivers using our 3G,4G, LTE, 5G and Satellite Broadband Bonding.

For specialized applications such as live video streaming from an ambulance or mobile clinic to a caregiver, 3G/4G/LTE/5G bonding appliances offer a unique way to provide Internet connectivity on the go. Mushroom Networks’ Portabella is a cellular bonding device that can take multiple cellular SIM cards from any carrier and combine them into a fast and robust Internet connection that is optimized for various application classes, including live video feed from a driving ambulance or mobile clinic connecting the patient to the doctor at a hospital.

SD-WAN virtual or physical appliances are ideal for taking over the burden of network management for healthcare locations, hospitals and mobile or temporary clinics:

• Zero-touch installation enables drop shipments to locations (fixed or mobile clinics) and allows them to connect seamlessly to the head office network and the data centers in a matter of minutes.
• Application Optimization with Broadband Bonding enables application-aware tunnels that connect branch clinic networks to the data center and other clinics while shielding the application from network problems.
• Centralized Monitoring Portal provides a single pane dashboard for all registered devices and enables remote access to each device if needed. Various telemetry and network statistics are stored in the Monitoring Portal for IT managers to have a comprehensive and actionable view of their network at their fingertips.
• Additional Features include elastic/static IP, automatic failover, advanced routing, firewalling, traffic shaping, layer 7 filtering, quality of service, bandwidth reservations and many more.

Looking Forward

Telehealth is currently transforming the healthcare landscape, and the changes will be dramatic. While many of these changes are already in place, they are not yet ubiquitous. Soon, healthy patients will be able to easily video chat with their primary care doctor or specialists; sick patients will be able to be diagnosed, treated, and recover at home with their vital signs being constantly monitored by their doctor; remote doctors or specialists will be able to assist or lead during live surgeries or other procedures.

But in order for this all to work, broadband access with redundant connections (i.e., no single point of failure) must be available. Rural populations continue to be behind the curve in this respect, but hopefully, recent media attention and government action will result in better broadband coverage.

Rob Stone, Mushroom Networks, Inc. 

Mushroom Networks is the provider of Broadband Bonding appliances that put your networks on auto-pilot. Application flows are intelligently routed around network problems such as latency, jitter and packet loss. Network problems are solved even before you can notice.

https://www.mushroomnetworks.com