In rural America, digital divide slows a vital path for telemedicine

This article originally appeared in The Boston Globe by Newton N. Minow and Ajit Pai.

KENTUCKY’S ALLEN COUNTY has 20,000 residents. Its school system serves about 3,100 students — but it has no pediatrician. The nearest one is 28 miles away. For years, when a child in the county seat of Scottsville became sick in school, parents and teachers didn’t have any good options.

But that’s now changed because of high-speed Internet access. Thanks to a digital connection between Allen County and Vanderbilt University’s Children’s Hospital in Tennessee, students in Scottsville simply walk to the school nurse’s office to see a top-notch pediatrician. Doctors can see their faraway patients on a screen, and parents can check in using an app. Everyone wins: Kids are healthier, parents don’t have to take time off work, teachers can focus on teaching, doctors can extend their expertise, and Scottsville is a stronger community.

This story illustrates that telemedicine — the delivery of health care services using communications technology — can be a critical tool for making Americans healthier. A concerted push to seize the untapped potential of telemedicine could help us tackle today’s health challenges.

Telemedicine has progressed quite a bit in recent years, and health care facilities have led the way. Today, the Cleveland Clinic deploys a mobile stroke unit with advanced wireless capability in order to assess and stabilize a patient 38 minutes more quickly than before (vital, since a stroke victim loses 2 million brain cells a minute). A hospital in rural Virginia uses technology to remotely monitor patients who’ve left the hospital, dramatically reducing sepsis. The Mayo Clinic serves more than 45 hospitals across nine states with an emergency telemedicine practice.

Telemedicine also can help address urgent public health challenges. For instance, the White House’s November report on combating the opioid epidemic highlights telemedicine as an integral part of the solution, especially for rural areas with limited access to health services. Telemedicine can connect opioid patients to caregivers when there is no other option. And wearable biosensors can detect real-time drug use and alert a family member or first responder to intervene.

Telemedicine also can empower patients directly. People with diabetes can now use digital tools to monitor blood-glucose levels. Simple smartphone apps can serve as behavioral coaches, which can have a huge impact, considering that an estimated 125,000 deaths a year result from patients failing to take prescribed medications.

While the benefits of digital health care are clear, we’ve been too slow to embrace its potential. According to a recent white paper, fewer than one in five Americans regularly benefit from telehealth services. It’s time we integrated communications technology into our health care system just as fully as we have in other parts of our lives.

The most crucial step in seizing the opportunities of digital medicine is making sure that every community has high-speed Internet access. More than 24 million Americans don’t even have the option of subscribing to home broadband service at the baseline speeds required for high-bandwidth applications such as telemedicine. Those who stand to benefit most from telemedicine disproportionately find themselves on the wrong side of the digital divide. Roughly 30 percent of rural Americans lack access to high-speed wireline broadband. (This exacerbates the fact that it’s harder than ever to attract physicians to practice in rural communities.)

The Federal Communications Commission plays a leading role in closing the digital divide. Currently, it’s finalizing a $2 billion plan to spur fixed broadband access and a $4.5 billion plan to promote mobile broadband, all in unserved areas. The FCC also operates a Rural Health Care program that offers $400 million a year to help health care providers afford connectivity. Demand for this funding exceeds the spending cap, and the agency is exploring whether to increase the size of the program and how to ensure that every dollar is stretched as far as possible. Meanwhile, the FCC’s Connect2Health Task Force is collaborating with the National Cancer Institute to study how broadband can improve cancer care for patients in struggling parts of Appalachia.

In addition to connectivity challenges, regulatory barriers holding back telehealth deserve examination. For example, the law currently requires an in-person medical evaluation prior to the prescription of a controlled substance. Relatedly, state licensing requirements can impede telehealth providers from treating patients across state lines — a problem interstate licensing reciprocity would overcome. The Federation of State Medical Boards is trying to work out licensure arrangements for this sort of interstate practice.

Extending Scottsville’s story to every part of America will be a challenge. But that’s no reason to relent. Both of us have different perspectives and may disagree on many issues and policies at the FCC. But on the importance of developing telemedicine, we share the same determination to move forward. Recent advances in communications technology could enable millions of Americans to live healthier, longer lives. Achieving that result requires forward-thinking policies on telemedicine. We’re firmly committed to helping America adopt those policies and bringing our health care system more fully into the digital age. As President Kennedy said, we “refuse to see this country, and all of us, shrink from these struggles which are our responsibility in our time.”

Newton N. Minow served as chairman of the Federal Communications Commission from 1961 to 1963. Ajit Pai has served in that position since 2017.

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