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Telemedicine expansion needs high speed Internet first

Legislators are seeking to expand telemedicine in Arizona, but rural and tribal communities that need it most might still not be able to access it without broadband Internet.

An estimated 898,724 Arizona residents have limited or no access to high-speed Internet – that’s according to the 2018 Arizona Statewide Broadband Strategic Plan and the Federal Communications Commission 2016 Broadband Progress Report.

Of the population lacking access, 410,794, or 63 percent, reside in rural areas, according to the plan, and 95 percent of people living on tribal lands have either unserved or underserved telecommunication infrastructure needs.

Telemedicine allows patients to be treated remotely through technology.

For example, if you lived in a rural area and needed to see a practitioner for an ear infection, you would go to a rural site where a trained nurse would connect with a practitioner over video. A high-resolution camera attached to a device that is used to look into your ear would then allow the practitioner to do the examination.

Telemedicine could also be used to combat the opioid epidemic by allowing those in rural areas to connect to treatment. The Centers for Disease Control and Prevention announced in October 2017 that the rates of drug overdose deaths are rising in rural areas of the country.

Stock photo

Stock photo

Sen. Heather Carter, R- Cave Creek, sponsored a bill that would require health care services that are covered in person to also be covered when provided through telemedicine. She said there are a few things to consider when scaling up telemedicine services.

“The infrastructure is obviously very important,” Carter said. “There have been a number of initiatives that we have supported here in the Legislature and with the executive office for the last few years to increase broadband access. Those efforts are still underway. Meanwhile, we don’t want to delay providing these services to people who have the technology means to receive them across the state of Arizona.”

Governor Doug Ducey’s budget for Fiscal Year 2020 proposes that a full-time state broadband director should be hired for coordinating all state government broadband planning.

There is $3 million set aside in the budget for a rural broadband development grants program, which would provide funding to help with the costs of expanding broadband services in underserved rural areas across the state.

The 2018 Arizona Statewide Broadband Strategic Plan was also developed by the Arizona Department of Administration in partnership with Mission Critical Partners to serve as a roadmap.

According to the plan, in 2017, the FCC identified counties with critical broadband needs in terms of impact to health care. Apache County was identified as “critical.” The Navajo Nation also reported barriers to improved Internet, the plan said.

Areas in northeastern and northwestern Arizona in particular have less broadband Internet access and fewer medical facilities. Meanwhile, urban areas have more broadband Internet access and more medical facilities.

Janet Major, who is director for education facilities for the Arizona Telemedicine Program, said Arizona is a state with very rugged terrain, which makes it expensive to build infrastructure here. She said once the rural infrastructure is completed, there aren’t a lot of people to sell the product to. As a result, she said grants for rural communities are critical.

“People can’t afford this, and it’s not a good business model for people who actually are in the business of selling infrastructure,” she said.

Major said telemedicine is growing in a way that is making not only medical care at a distance more accessible, but it is also improving efficiency in terms of the business model of health care.

“There are a lot of schools that are now working toward implementing telemedicine services because they have the broadband,” Major said. “More broadband is definitely needed, but I think that we’re doing a better job at what we have.”

Major said there are parts of Arizona where people will never have broadband Internet access in their home.

“One thing that we have to look at in terms of the future is how do we connect those people, people who don’t have the iPhone, an iPad or that kind of connectivity, where are we going to be able to connect people in a way that they can be in a public place and still have a private conversation about their health care?” Major said.

One idea, she said, is the concept of a kiosk that could connect people to health care in places like libraries that would have Internet.

Michael Holcomb, the associate director for information technology with the Arizona Telemedicine Program at the University of Arizona, said telemedicine is becoming a standard of care for certain applications.

One example is telestroke. A person having a stroke has only a few hours to get to a clinic. Telestroke could help patients see somebody immediately as opposed to having to travel hours away.

“Using simple measurements, in many cases, body weight changes, taking daily blood pressure and those kinds of things and relaying that information back to a central facility that is monitored (is another example),” Holcomb said. “Then, if they detect differences that are significant, they can contact the patient.”

Dr. Ronald Weinstein, director of the Arizona Telemedicine Program, said services such as telestroke will work in rural hospitals that have broadband access.

“But as you get further out, where there might not be ready access to a place with broadband, that kind of service might be difficult to get access to,” he said.

Weinstein said there are categories of cases where a small hospital or a surgery center would not give an operation if they did not have access to pathologists to look at rapid diagnosis on what are called frozen sections.

“The technology to do that now exists,” Weinstein said, “but it really requires having some access to broadband.”

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