The Federal Communications Commission is interested in increasing its support of rural communities, and is eyeing ways to help health care organizations expand care beyond buildings.
According to FCC Commissioner Brendan Carr, the commission historically has supported getting broadband to buildings, but now wants to help organizations take internet and mobile devices afield. Carr toured the University of Virginia Medical Center on Monday and learned about telehealth — the practice of examining and treating patients remotely.
“It’s essentially any tool you’d have in a clinic, right here,” Carr said, gesturing at a blood pressure cuff, a blood sugar monitor and a video diagnostic wand on a conference table. Each can be connected to an app to track vital signs and send to a physician.
“There’s a lot that we do that tangentially benefits this,” Carr said. “But I’ve been thinking about if there’s more that we can do in this connected care model, this role of health care, for us as a commission to continue to support these efforts.”
High-speed internet and cell coverage has enabled UVa doctors to treat certain patients in rural areas, in high-risk situations and in the back of ambulances.
Dr. Andrew Southerland, a neurologist at the Medical Center, has helped to develop a system where emergency medical techs can rig an iPad in the back of an ambulance and video call Southerland when a patient might be suffering a stroke.
“Being diagnosed with a stroke before [arriving at] the hospital can make a literal difference between spending the rest of your life in a nursing home and going home to your family,” Southerland said.
If Southerland or another neurologist is able to assess a patient’s symptoms and prescribe clot-busting medication quickly, a patient might retain millions of brain cells, receive necessary care more quickly at the hospital, and get diverted to a different facility, if necessary, for specialty surgery.
Doctors also use mobile and video technology to assess and treat patients from afar for preventative or chronic diseases.
April Morrison, the clinical nurse manager of emergency services at Culpeper Regional Hospital, frequently opens videochats so Culpeper’s emergency team can decide whether to send patients on the 45-minute ambulance ride to UVa.
“This program has been amazing for us,” Morrison said. “Sometimes, too, the best we’re able to offer is not just the ability to treat patients but to keep patients that don’t need it close to home and save their money.”
Doctors also demonstrated diabetes and behavioral health services.
“Being connected is more important than ever,” said Dr. Karen Rheuban, medical director of telemedicine at UVa.
Often, she said, it’s easier for patients in rural areas to open an app on their phone than to drive two hours to the nearest clinic.
UVa doctors make thousands of remote visits annually, and have tried to increase telemedical visits for diagnoses that are acute and difficult to do from a distance, such as bladder cancer.
However, telemedicine only works in communities with fast and reliable internet.
The FCC has labeled Louisa and Buckingham counties as two of the 100 critical need counties across the country. Only 42 percent and 43 percent of residents in those counties, respectively, have access to broadband, compared with 90 percent of residents nationally.
The commission voted last week to increase subsidies for its rural health program from $400 million to $571 million. The fund helps rural communities to pay for telecommunications and record transmitting services, and has had the same $400 million cap since 1997. It’s meant to get internet to houses, schools and hospitals, though not necessarily in the back of a moving ambulance.
“I think that’s a great program, but I’ve been thinking about how to expand it,” Carr said.
Industry providers have raised concerns that the FCC’s recent decision to roll back net neutrality and introduce a tiered system in which service providers can charge more for high-speed internet will hurt rural and community providers.
“I think the decision to roll back net neutrality, which I voted for, will be tremendously beneficial for consumers in general and the telehealth community,” Carr said. “Generally, when we talk about connectivity, places that lack broadband are rural areas with a lot of chronic health diseases.”
Rolling back regulation will help private companies invest more in telehealth, Carr said. He said he doesn’t envision a big price hike when the rules return to what they were in 2015. He said he also hopes a push to put the country on 5G coverage will increase the speed and breadth of access.
“When you look two to three years from now, I think we’ll have more choices and lots more coverage, particularly in rural areas, and more ability for you to do what you do,” Carr said.