When I had a stroke five years ago at 10:20 on a Saturday night, telehealth saved my life. At the time, only 3% to 5% of people in the United States were able to get the “clot-busting” drug called tPA in time to avoid brain damage.
Fortunately, I lived in Alameda, California, just five minutes from Alameda Hospital. But in many parts of the country people are two and three hours from the nearest hospital. I could have died before I got treatment elsewhere.
Even though COVID-19 has made telehealth popular for enabling people to visit doctors while avoiding germ-laden waiting rooms, quite a few consumers aren’t aware of the full range of telehealth or the technology’s potential benefits. It takes a little time to understand its virtues and values. But understand this: Without broadband, there’s no telehealth.
Telehealth is the full-on digitization of healthcare by using internet access and intranets to facilitate the entire continuum of care to prevent, treat, and ideally cure any type of sickness, injury, and ailment in the body or the mind. This continuum could be simple as a one-time video chat with the doctor. Or it can be extensive involving various specialists, medical staff, and healthcare resources.
My up-close and personal experience with telehealth, immersion into research on the topic, and 15 years of experience with broadband planning fuels my belief the two technologies can bridge the healthcare gap. Between doctor shortages, hospitals closing across the country, and the pandemic, we have no choice. It’s time to quickly learn, adapt, and perform.
The stroke treatment continuum
Five years ago on that Saturday evening, when I realized something was wrong and called some good friends, I was lucky that they were still awake. In the U.S., one-third of 45- to 63-year-olds are single and run the risk of suffering a stroke without anyone else knowing. As smart-home technology moves from hype (“smart refrigerator—mix me a drink as I park the car”) to practical applications, expect to have sophisticated sensors that can tell if you had a stroke or too many smart-refrigerator drinks.
Alameda Hospital’s Stroke Center has a goal: “door-to-needle” in 25 minutes. That’s the time between when a stretcher hits the ER door to when the stroke team examines, diagnoses, and starts administering tPA to a patient. I arrived at the hospital at 10:30 p.m. Neurologist and Stroke Center Medical director Dr. Claudine Dutaret had dialed in from home and put the team through its paces. Just shy of 10:55 p.m., I started treatment.
With telestroke networks, there’s always a neurologist on call to guide the smaller hospitals’ treatment of a stroke patient.
Currently, there are also more than two dozen telestroke networks in the United States. At the hub of each is a large hospital with on-call neurologists, and broadband that connects the hospital directly to satellite hospitals and clinics. There’s always a neurologist on call to guide the smaller hospital staffs’ treatment of a stroke patient.
Until 2008, Arkansas led the nation in stroke-related deaths. Only 1% of patients received tPA. Then the University of Arkansas Medical Sciences (UAMS) tapped into the state-owned broadband network to build a telestroke network (AR SAVES, or Arkansas Stroke Assistance through Virtual Emergency Support) that links 53 of the 80 hospitals in the state. Now 33% of stroke patients in Arkansas receive tPA and the state moved down six slots in 2016.
Rehab: The longest mile
Until the COVID-19 pandemic hit, government regulations strangled much of telehealth. For one thing, a lot of telehealth had to be delivered from a medical facility or doctor’s office, which can mean a world of a hassle, aggravation, and costs. Also, the insurance industry convinced some state legislators to pass laws that prevent doctors from charging as much for a telehealth consult as for an in-person visit.
Now that COVID-19 has taken the handcuffs off telehealth, the technology is popular with doctors and patients. Senior citizens, people with mental health needs, and patients with disabilities or chronic conditions give it two thumbs up.
After spending six weeks in the hospital in 2015, I did long-term rehab at home with a group called Rehab Without Walls. Telehealth would have been a spectacular bonus. Only 35% of physical therapy patients fully adhere to their plans of care, and just 30% of patients who receive outpatient physical therapy services actually attend all the visits their insurance company authorizes.
My crew of occupational, physical, and speech therapists did miracle work getting me ready for my first in-person speaking gig five months after my stroke. Rehab is a necessary and vital part of the healing process. But it is a boring, mostly solitary endeavor that is financially and logistically difficult to deliver in quantities that patients need. With telehealth and AI, the crew could have had me running on water.
Rehab is part of the continuum of care for quite a few ailments, injuries, and surgeries, including heart attacks, hip replacement, and strokes. Telehealth, web apps and content, artificial intelligence, and 3D-printing promise to bring entertainment value, friendly competition, and a sense of community to the rehab process.
How telehealth can narrow the healthcare gap
My medical journey started with a telehealth intervention, and it was great. But the true awesomeness of this evolutionary technology is its potential to close the healthcare gap—that divide between those who have access to affordable quality healthcare, and those who do not.
After studying telehealth for three years, I have a few thoughts on how communities can start to formulate telehealth strategy.
Reinventing the doctor visit. 45 million Americans don’t have insurance. Twenty-eight percent of U.S. men and 17% of women don’t have a personal doctor or healthcare provider. But an analysis by the Kaiser Family Foundation shows higher rates for minorities, such as 33% of Hispanic women and 31% of African American men. What’s more, people of color have decades-long history of bias and abuse at the hands of healthcare.
Community leaders should consider alternatives to the traditional doctor’s offices. Forty-three percent of African Americans have hypertension or high blood pressure. Converting barbershops and hair salons into hypertension screening stations can work.
Marrying chronic healthcare and home care. According to the CDC, 6 out of 10 people in the U.S. suffer from a chronic disease. Four out of 10 people suffer from two. Diabetes is 60% more common in African Americans and the men are 50% more likely to get lung cancer.
We should consider giving unserved communities the power to collectively negotiate deals with hospitals, insurers, and employers in which these entities underwrite broadband and telehealth infrastructure that the communities own.
Enhancing emergency response and trauma care. In addition to offering telestroke capabilities, healthcare providers should equip emergency vehicles with portable ultrasound devices and defibrillators. Rural communities can consider strategically deploying high-powered wired and wireless hotspots in case patients need immediate medical attention while still en route to the hospital. Following natural disasters such as earthquakes or floods, mobile hotspots configured for telehealth could be helicoptered into isolated communities.
Spreading mental health care. Fifty percent of Americans in general have the mental healthcare professionals they need. Only 20% of rural folks and 30% of African Americans do. Telehealth is helpful for delivering mental healthcare services, but it should be supported with distant learning and online training to create a local mental health workforce.
Improving senior care and aging in place. A recent survey conducted by CVS Health revealed that individuals 65 and older have a strong desire to maintain their independence for as long as possible, with nearly 8 in 10 seniors noting that they plan to “age in place.”
Telehealth can have a huge impact on senior healthcare and aging in place, especially in underserved and marginalized communities. But the technology is only as good as the quality of the broadband network that it’s built upon. Broadband has to be part of the solution.
Reimagining hospital care. Mitigating hospital closings may be telehealth’s greatest challenge. These closings in poor urban and rural communities are making the healthcare crises worse. It’s time to reimagine what hospitals can be.
What we think a hospital should be often has been dictated by ego, tradition, expediency, and profits, and marinated in the belief that only corporate hospitals can deliver healthcare well. We should consider, for example, creating alternate healthcare facilities using underutilized hotels or motels to house and monitor patients such as those recovering from surgical procedures.
I’m bullish on telehealth, particularly after my experience with it. But make no mistake, to narrow the healthcare gap requires more than thought, prayers, and the latest medical gadgets. At the city or county level, it requires a vision, a plan, community stakeholder support, political will, creativity, and money. And broadband. Great broadband.
Saved from a stroke by telehealth, Craig Settles is paying it forward by uniting community broadband teams and healthcare stakeholders through telehealth initiatives. He’s a community broadband analyst and consultant assisting communities with broadband and telehealth planning.