Almost half of U.S. counties face a “double burden” of chronic disease and a need for greater broadband connectivity, according to a new report filed with the FCC. The report comes from an advisory committee that was set up to identify barriers to telehealth and recommend solutions.

The majority of “double burden” areas fall into what the report calls “clusters” of five or more counties with total populations exceeding 100,000.

An “overall shortfall” in access to adequate broadband in rural areas limits the ability to deploy telehealth, the report notes, but the authors add that “people-based” issues are some of the most significant challenges related to the adoption of telehealth.

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“The process of elected officials developing appropriate regulatory guidance and legislation and licensing criterion for providers is complex and is complicated more by advocacy positions than by generally held policy principles,” the authors observe.

FCC Telehealth Barriers Report
The report stops short of recommending a specific broadband speed to support telehealth, but instead describes applications that broadband connections should support, including:

  • Live video with image and audio quality sufficient for a healthcare provider to assess a patient, with the video enabling the ability to distinguish facial expressions, insect bites or rashes and labels of medications. The audio should be clear enough to avoid adding to the difficulty of understanding local accents, non-native English speakers’ pronunciations and people with disabilities. It also should preserve intonations, tremolos and other non-verbal sounds relevant to understand stress levels.
  • Both audio and video refresh rate should be fast enough to provide continuous quality images while the camera is in motion and provide no delay between the audio and video. The lag between transmission by the patient and viewing by the provider should be less than a few seconds to reduce cross-talk.
  • Access to the latest patient information should include lab results, medication and previous telehealth video recordings.
  • Underlying Wi-Fi and cellular networks should be available for redundancy.
  • Low latency in data packets should be defined as the transition time between each hop in the network. And because each hop adds to total latency, minimizing hops is important.

The report also notes that telehealth could be very beneficial in response to a disaster. “Telehealth coordination should include the identification of communication and contingency systems that are rapidly deployable in areas with compromised communication service,” the authors wrote.

Apart from the technology issues, the new report identifies six areas where regulatory or policy barriers exist, including:

  • Reimbursement
  • Licensing
  • Health information exchanges
  • Insurance parity and malpractice coverage
  • Privacy- information sharing and HIPAA
  • Establishing a doctor/patient telehealth-based relationship

It also includes several examples of what has been done at the state-level to further telehealth and describes what has and hasn’t worked well in the states studied. The full report is available at this link.

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