Telemedicine and Broadband Access

North Carolina’s Broadband Infrastructure Office and the NC Department of Health and Human Services published a 77-page report that compares the state of healthcare and broadband access in Western North Carolina. I expect to soon see similar reports from around the country as States are taking a hard look at broadband access and related issues.

Western North Carolina is in Appalachia and has higher rates of poverty than the rest of the state. Many of the counties in the region had economies driven by coal extraction and related supply chains. These areas were already seeing economic devastation before the pandemic.

As might be expected, the report shows that deaths from diabetes, stroke, heart disease, opioid use, COPD, and unintentional injuries are higher in western North Carolina than in the state’s metropolitan areas. The region has far fewer doctors per 10,000 population than the rest of the state.

There had already been a start for bringing telemedicine to the region. For example, Mission Health, a large health care provider in Asheville had already been working with rural hospitals in a few western counties to bring access to specialists. But like everywhere else in the country, the need for telemedicine has exploded since the advent of the pandemic.

As might be expected, broadband access is low in many of these counties. Western North Carolina is like the rest of Appalachia, with hilly and mountainous terrain, a lot of woods, narrow and winding country roads, and scattered rural populations. The counties in the region have already identified the lack of broadband as a major problem before the pandemic and have been taking steps to try to attract ISPs to the region.

This study is the first step attempt in correlating broadband access to the availability of health care. One of the first steps taken in the study was to equate the broadband adoption rate in counties to the degree to which a county has higher death rates than the rest of the state. Interestingly, there were no counties with high broadband adoptions that rated below average for health statistics. However, only 3 or the 20 counties were rated as having high broadband adoption rates.

The study surveyed what the report called safety net sites – locations that provide health care to low-income people. They found that 70% of these locations were already using telemedicine before the pandemic. However, most of these health care providers said they were underutilizing telemedicine. The study showed that many of the health care facilities don’t have an affordable or reliable broadband connection, making it hard for them to reliably conduct telemedicine.

The State Broadband Office had identified almost 72,000 homes in these rural counties that don’t have access to broadband at home, meaning there is no ISP able to provide a broadband connection capable of delivering telemedicine. Telemedicine platforms differ, but I’ve been told that most telemedicine connections require both a download and an upload connection of between 3 Mbps and 4 Mbps. Anybody living in a rural area knows that an upload speed of that magnitude is a rarity.

The study also showed that even where broadband is available that 17 of the 20 counties have lower than average rates of computer ownership and broadband adoption. The study correlates this with the level of poverty, which is also lower in these areas than average for the State.

This study is an important step in understanding the broadband gaps in Western North Carolina, and telemedicine is only one of the many ways that lack of broadband is hurting the region. If any good has come out of the pandemic, it’s that state government has turned its attention to the huge problems caused by poor broadband in rural areas. Hopefully, this will translate into finding broadband solutions – which is going to be a huge challenge in Appalachia.

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