Telemedicine Needs Big Bandwidth

Medical_Software_Logo,_by_Harry_GouvasThe Federal Government is a big believer in telemedicine and there are several branches of the government that have been vigorously pursuing it as a way to better treat patients. Some of these initiatives include:

  • The Department of Veterans Affairs kicked off their telehealth program in 2011 named Special Care Access Network – Extension for Community Healthcare Outcomes (SCAN-ECHO). This program is aimed at providing care to veterans without requiring them to travel to a VA hospital. In some parts of the country VA hospitals are widely scattered and the VA knows that a lot of doctor visits are routine and can be handed adequately through telemedicine links.
  • The Department of Defense started working on a telemedicine program almost two decades ago for use on the battlefield. Their telemedicine links allow specialists to weigh in on battlefield injuries along with field medics, and they had great results in Iraq and Afghanistan. The DoD has named their system ECHO and has recently licensed it to Kaiser Permanente. The hospital chain sees use of the technology to field triage accident victims and to use for their patients who can’t make it to a hospital.
  • The Air Force has been working on a focused telemedicine program for the last four years. Instead of working on remotely treating patients, which is being pioneered by others, they have been focused on four specific areas within teleimaging: teleradiology, telecardiology, tele-endoscopy and telepathology. In a nutshell they are working with field devices that can create the diagnostic images that telemedicine doctors need to better treat field injuries. This would provide more detailed diagnostics for accident victims and remote patients who can’t easily get to a hospital.

Telemedicine is a priority for the Veterans Administration which reports that they are today treating 380,000 vets who live in rural areas. They have nearly 11,000 veteran patients now using the VA’s tele-audiology system, but they would like to greatly expand their telemedicine capabilities.

What all of these programs have come to realize is that the broadband in rural America is not adequate for what they are trying to do. One thing every one of the above efforts needs is big broadband capacity to connect to patients through video links or to transmit gigantic imaging files.

The military is used to having big broadband on the battlefield. We tend to think of satellite data links as small bandwidth and slow connections, but satellites can download significant bandwidth pipes with the right receivers and at the right price. I would assume (but don’t know) that the military has their own data satellites in orbit to provide bandwidth on the battlefield.

So these agencies are adding their voice to the cry for better rural broadband, which is the primary place where intensive telemedicine technologies are most needed. As these agencies are moving battlefield-tested technology into the civilian world they are bumping up against the same rural bandwidth limits that others have been seeing for years.

Just last week the FCC boldly increased the definition or broadband in the country to 25 Mbps download and 4 Mbps upload. According to the FCC’s numbers this means that 55 million Americans, or 17 percent of the population do not have access to broadband.

If you have followed my blog you know that I think the number is even higher than that since the FCC’s estimate is based upon a very flawed National Broadband Map, which is populated by the carriers. But one can be pretty certain that the vast majority of the people who can’t get the FCC’s newly defined broadband live in rural areas.

I have worked for years with rural communities and the lack of broadband has some real life repercussions for the people living there. There are numerous rural communities without hospitals, without doctors and without universities, and the people who live in these remote places have to undertake long drives to do things the rest of us consider as routine like see a doctor or take a class.

Telemedicine has a huge potential for diagnosing and treating rural patients. It is already being used worldwide to bring modern healthcare into remote communities. But I find it sad that many places in our own country can’t have this great technology due to the lack of broadband infrastructure.

7 thoughts on “Telemedicine Needs Big Bandwidth

  1. Three thoughts:

    1. My health care provider is the VA. Fortunately I live 1 mile from the current regional hospital and actually walk to my annual check up. As I approach the complex I notice VA vans with license plates from surrounding states (here in CO, that means a REAL long ride) full of old boys. I feel their pain. Why can’t they visit a Registered Nurse or Physicians Assistant in their home towns, get in front of a video camera and say “Doc, it hurts when I do this.”? Answer: VA will not consider buying bandwidth from local providers. They will only deal with Big Three telcos for Internet connections. This must change.
    2. I will believe VA’s marketing fluff on telemedicine when I see it in the field. A year ago I attended a broadband meeting in Alamosa, CO. Alamosa County’ government’s veteran advocate spoke of the need for better broadband to support telemedicine at the local VA clinic. Also attending was the owner/operator of a local fiber broadband company (descended from a near by telco and Alan is the 3rd generation owner operator, not like its a start-up). Despite his efforts the VA would only buy bandwidth from CenturyLink whose product is inadequate to support serious telemedicine. Ergo, your tax dollars go up in diesel smoke on the big vans hauling veterans from Alamos to Denver (4 hours one way).
    3. Completely agree that National Broadband Map is flawed based on service provider sell-reporting. While I agree with Wheeler’s decision to up the numbers to 25/3, objections from Commissioners Pai and O’Reilly used the word “charade”, a term with which I don’t disagree in describing the Map and its reliance on service provider self-reporting.

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    • Bureaucratic stupidity knows no bounds. Here is an example of a government agency, the VA, not being able to buy a broadband connection that was probably built, in part by another federal agency. You would think it would be easy for a federal agency to do the right thing, but we often see that it is not.

      We all know that in much or rural America the big phone companies are nowhere to be found. There is often no option but to buy bandwidth from the independent telephone company, the coop or the municipality. How hard is it to figure that out?

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    • You are right in that a cable modem line is probably adequate to make a basic telemedicine link. The problem is that people living in rural areas don’t have that. While an urban cable modem might have a speed of 15 Mbps download and 1 Mbps upload, speeds in rural areas are far below that. A rural cable modem or DSL might only have an upload speed of 512k, meaning it’s not fast enough to create a link where the doctor can see the patient. And there are millions of rural people still on dial-up or satellite connections that are even worse.

      Second, telemedicine is changing. In the first generation of telemedicine doctors have been able to talk to patients, which is what you might have seen overseas. But they are trying to advance telemedicine to the point where it is an equal substitute for seeing a doctor. That means getting a close-up look at your symptoms and not a fuzzy picture of your face. And ultimately it means being able to relay advanced diagnostics like cat scans and MRIs from a rural health location, which requires very large bandwidth.

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