For people living in Wyoming or South Dakota or rural Virginia, a trip to the cardiologist isn’t a simple undertaking. “They’re taking a whole day off work to drive 150 miles, go the appointment, and drive 150 miles home,” says Deanna Larson, senior vice president at Avera Health. That’s why Avera, which runs a network of over a hundred clinics and hospitals in the upper midwest, has invested in telemedicine, allowing doctors to pop into rural clinics by video from hundreds of miles away. Telemedicine has been a buzzword for years now, but the rural communities that could benefit most from it also have the least access to fast and reliable Internet—an obvious prerequisite. That’s not for lack of political effort. The Federal Communications Commission has been responsible for helping connect rural healthcare facilities since the Telecommunications Reform Act of 1996. The Internet has changed since then: Bulky desktops have shrunk to pocket iPhones and 56 kpbs dial ups have been superseded by 35 Mbps connections—nearly 10,000 times faster. The 20-year-old law, even after a few revisions, has struggled to keep up. Telemedicine infrastructure is lagging on two fronts. First, many rural clinics have Internet access that is still too slow and unreliable. Second, telemedicine is increasingly moving from the clinic into the home, with at-home monitoring and mobile apps. Here, the facts on the ground are even worse: According to the FCC’s 2015 Broadband Progress Report, 55 million Americans still do not have access to broadband speed Internet access, which includes more than half of rural Americans. The FCC’s rural health care program can give out $400 million every year to link up rural health facilities. “It’s never reached anywhere near that limit,” says Jonathan Linkous, CEO of the American Telemedicine Association. In 2013, the rural health care program paid out $159 million. Linkous chalks up it up the program’s complex bureaucracy, which the overworked staff members at rural clinics don’t have time to navigate. Rural clinics do have usually have broadband connections now, but they can be T1 lines, which top out at just 1.544 Mbps. (In comparison, Comcast offers cable Internet up to 150 Mbps in the San Francisco area.) Avera requires its facilities to have a T1 line, and it lays lines for ones that do not, like for a facility in remote Montana. That’s fast enough for a video consult, but it’s not necessarily enough for, say, an electronic intensive care unit, in which healthcare professionals remotely monitor patients who need critical care. “There are significant rural areas that still do not have the speed necessary to do the telemedicine they would like,” says Alan Morgan, CEO of the National Rural Health Association. As broadbroad in rural health facilities is still lagging behind, mobile health apps are blowing the problem wide open. “If you’re still providing broadband to brick and mortar, you’re going to where healthcare used to be,” says Linkous. “More and more, you have to get beyond the traditional walls of hospitals and clinics.” In 2014, for example, the University of Mississippi Medical Center began a pilot programthat sent 85 patients with uncontrolled diabetes home with a tablet. The tablet kept track of blood glucose levels and sent real-time data back to a team of doctors. The first six months of the study have been promising: The diabetes patients lost weight and reported getting their diabetes under control. But for programs like this diabetes pilot to work, patients need reliable Internet access at home. That’s not a given, with half of rural Americans still lacking broadband-level speeds. And if you’ve ever driven across the country, you’ve certainly driven through vast tracts of land without cell phone access. The FCC and the US Department of Agriculture both have programs dedicated to promoting rural broadband—modeled after the 20th century push for rural telephone service. But the programs haven’t been as widely successful yet. The USDA’s Rural Utilities Service, especially, has come under fire for spending money in all the wrong places. One bright spot is the FCC’s recently proposed changes to its Lifeline program, says Linkous. Lifeline has given millions of low-income Americans a $9.25 per month subsidy to pay for a mobile or landline phone, and the FCC is now considering broadening the program to include broadband. WIRED readers, of all people, can probably get behind universal Internet access—but the FCC’s decision could actually help make that real.
Telemedicine is a natural fit for consultations with those in rural or remote areas, who will often have to travel long distances for a face-to-face appointment with a physician, however, internet infrastructure - both at home, and within designated rural telemedicine clinics - is still lagging behind. 55 million Americans do not have access to broadband speed internet, a figure overwhelmingly skewed towards the rural population. The FCC has been working on this issue since 2015, when it issued its first rule requiring that all providers of telecommunications services offer their customers “reasonable network management” options as part of any service contract.