Engagement on Equity: Connectivity and the Future of Healthcare
Wednesday, October 16, 2019
Engagement on Equity:
Connectivity and the Future of Healthcare
Mignon Clyburn, Member of the Board of the Benton Institute for Broadband and Society and
Former-Chairwoman and Commissioner on the
Federal Communications Commission
Government-University-Industry Research Roundtable
The National Academies of Sciences | Engineering | Medicine
(remarks as prepared for delivery)
Good morning and thank you for that kind introduction. What an honor it is to be part of this gathering of the nation's pre-eminent source of high-quality, objective advice on science, engineering, and health matters.
This morning I wish to speak about how bridging the digital divide could help address our nation’s persistent health disparities.
During my tenure at the Federal Communications Commission, I urged Chairman Wheeler, to create a dedicated, interdisciplinary team, keenly focused on the intersection of broadband, advanced technology, and health.
That team known as the Connect2Health Task Force, found that the picture of health is vastly different in connected communities, versus those digitally isolated areas. This is especially true, when it comes to access to care, quality of care, and health outcomes.
But the tie that also binds is the lack of high-speed broadband connectivity in low-income communities, too. Rural America, as you know, is facing a physician shortage and low-income and rural populations are less likely to have choice when it comes to broadband providers. Allow me to be more direct: in those places where there is a wealth and/or population gap, there is a health care and broadband availability gap.
A new study from the University of Pittsburgh clearly illustrates that where there are fewer doctors, there is also less broadband:
- counties with adequate access to primary care physicians and psychiatrists had 62 percent broadband coverage;
- counties with inadequate access to primary care physicians had 39 percent broadband coverage; and
- counties with inadequate access to psychiatrists had 49 percent broadband coverage.
While the challenge is clear, the cure is even clearer. With broadband connectivity, patients with virtually any condition can be seen remotely by a specialist without having to drive anywhere at all. So should come as no surprise that 52 percent of hospitals now use at least some form of telehealth, another 10 percent are just ramping up and we expect more to come on board.[iii]
What does this make clear? That a healthy America, is a connected America. Conversely, if we fail to fully address America’s broadband connectivity gap – when it comes, to health and wellness in rural America -- none of us, will be completely well.
Real, High-Performance Broadband can help solve some of health care’s most enduring problems and intractable challenges... and it can do so by delivering massive cost-saving opportunities. It can slow runaway health-care cost growth,[iv] enable patients to harness a new generation of connected-care devices that help them live longer and more productive lives and extend connected care everywhere while closing the rural health-care gap.
Advances in telemedicine are already transforming health care because delivery is no longer solely depended on traditional brick-and-mortar facilities. Broadband increasingly delivers connected care options to patients at home and on the go and early evidence suggests, that telemedicine can result in shorter hospital stays, lower mortality while recovering at home, and less frequent need for follow-up appointments. Telehealth connections allow certain at-risk populations, including the elderly and patients with chronic health conditions, to stay at home longer and those with disabilities are also benefiting from the convenience of telehealth often at significant cost savings.
But full-blown telehealth requires bandwidth—in medical facilities and in patients’ homes. In 2017, the Congressional Research Service found that hospitals require at least 1 Gbps to share medical records, perform virtual consultations, and connect first responders. Medical imaging and testing devices have taken advantage of the rapidly decreasing digital-information storage costs and more plentiful bandwidth, with 20-megabyte 2-D high-resolution images giving way to 3-D images composed of hundreds of megabytes of data. As do schools and libraries, health-care providers need to develop more robust local area networks and Wi-Fi systems to meet the rapid proliferation of digital devices.
One hospital estimated that its network should be able to support 10,000 wireless devices at any one time.
State and local governments are beginning to recognize the importance of broadband-supported health care in rural areas. For example, California and Idaho fund telehealth efforts that connect rural locations to medical providers. Arizona’s 2018 Broadband Strategic Plan specifically calls for broadband expansion to rural health-care providers to assist in the treatment of health issues that include diabetes and opioid addiction.
And while state programs to improve connectivity for telehealth programs are relatively scarce, their acceptance by state medical support programs like Medicaid is becoming more common. For example, 49 states provide some form of reimbursement for live video-based services, while 20 states currently provide Medicaid reimbursements for remote patient monitoring. Some states, like Kansas, have passed laws that require reimbursements over a relatively wide range of telehealth methods.
Federal efforts to date, however, have tended to focus primarily on rural health care. The FCC subsidizes the cost of broadband to rural health-care providers with prices that are established through a competitive process. Eligible costs include up-front charges for deployment of new or upgraded broadband facilities and lit- or dark-fiber leases.
Ubiquitous High-Performance Broadband, however, will allow more doctors and medical professionals to make more house calls without leaving their offices, improving treatment—and the quality of people’s lives. Remote medication-dispensing systems will provide better management of drugs and adherence to prescription routines.[v] Sensors and other monitoring techniques will be more usable in patients’ homes, allowing the elderly to stay in their homes more and travel for medical care less.[vi]
In sum, broadband connections are critical for bending the health-care cost curve that currently has too many Americans spending too much on care. To cut costs and improve care, hospitals today don’t just send patients home with a handful of prescriptions. Instead, they often take advantage of broadband to send patients home with an armful of broadband-enabled devices: digital scales, blood pressure monitors, oximeters, and portable EKG monitors. These new tools help doctors discharge patients earlier, care for them better, avoid costly readmissions, and improve care.
And by tackling one of the most challenging cost centers in health care—the $17 billion we spend annually on preventable readmissions—broadband-enabled devices enable patients to spend more time at home with family and lessen travel burdens and costs to caregivers.
So, when we think about disparities in health, let’s not forget the connection between health care and broadband connectivity. Emerging technology applications can address disparities—if we ensure equitable deployment of High-Performance Broadband to communities around the country. I think of this as the “health safety net.”
Let us aim to meet the health needs of every single American, regardless of where they live and leverage High-Performance Broadband to do so. While connectivity may not resolve every single health challenge, it certainly has capacity to solve most of them.
The deployment of High-Performance Broadband can be the oasis in a health care and wellness desert. And if our aim is a more equitable society, we cannot neglect this most basic human concern: living a healthy life. Investing in broadband gets us there.
Mignon Clyburn served as a Commissioner on the Federal Communications Commission from 2009 to 2018, including a term as Acting Chairwoman in 2013. Her tenure was marked by her commitment to closing the digital divide, championing diversity in media ownership, reforming Inmate Calling Services, and preserving a free and open internet. Clyburn is currently an Open Society Foundations Leadership in Government Fellow. Serves on Benton’s Planning and Programs Committee.
[i] National Rural Health Association https://www.ruralhealthweb.org/about-nrha/about-rural-health-care
[ii]The plight of America's rural health care https://www.axios.com/the-plight-of-americas-rural-health-care-a34b6c66-7674-4f78-abdc-33f8e711a601.html; CDC: More obesity in U.S. rural counties than in urban counties https://www.cdc.gov/media/releases/2018/s0614-obesity-rates.html; The Burden of Diabetes in Rural America https://www.ruralhealthresearch.org/projects/100002380; https://www.cdc.gov/ruralhealth/cancer.html.
[iii] Telemedicine: Using Remote Monitoring to Reduce Hospital Readmissions, Milking Institute School of Public Health, Oct 30, 2015 https://mha.gwu.edu/blog/telemedicine-reduce-hospital-readmissions/
[iv] Accenture estimates artificial intelligence alone (usually only accessible via broadband enabled cloud services) could potentially create $150 billion in annual savings for the US healthcare economy by 2026. https://www.accenture.com/us-en/insight-artificial-intelligence-healthcare
[v]5 Benefits of Internet of Things for Hospitals and Healthcare https://archer-soft.com/en/blog/5-benefits-internet-things-hospitals-and-healthcare
[vi] Rick Schadelbauer, “Anticipating Economic Returns of Rural Healthcare,” NTCA–The Rural Broadband Association, March 2017, 8-11, citing Whitacre; Telemedicine: A Promising Model for Senior Health Care https://www.agingcare.com/Articles/Telemedicine-A-Promising-Model-for-Senior-Health-Care-191659.htm; Telehealth And Seniors https://www.aginginplace.org/telehealth-and-seniors/
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