According to the National Rural Health Association, roughly 25 percent of the U.S. population lives in rural areas, but only 10 percent of the nation’s doctors practice there. In addition, the density of specialists – such as neurologists and radiologists – is even lower, making it difficult and costly for those suffering from conditions such as Parkinson’s disease to manage their condition.

Some clues as to how this situation could be improved can be found by looking north. According to a recent report by NPR, Canada is leading in the deployment of video imaging as part of its telehealth initiative. The results are compelling: More than 1,000 videoconference sites are now deployed across the country, leading to enhanced care for rural patients. The Canadian government reports that more than 5,700 telehealth systems now support 1,175 communities, while Ontario reports that in 2010 more than 90,000 virtual patient visits were recorded on the Ontario Telehealth Network (OTN) and the use of the network has saved more than 83.3 million miles (134 million km) in patient travel since 2006.

The success of Canada’s early telehealth initiatives provides good context for the inception of the American Recovery and Reinvestment Act (ARRA) of 2009, which allocated more than $20 billion in funding for the adoption of healthcare IT systems and electronic healthcare records for a number of reasons:

Patient Access – By investing in a national telehealth infrastructure, those in rural and underserved regions are able to have access to quality care without traveling long distances to metropolitan areas where most specialized services and medical experts are located.

Information Access – By establishing a nationwide system that would allow practitioners secure access to patient records, non-primary care physicians important will have data at their disposal when deciding on the best course of treatment, especially in emergencies.

Health and Productivity – Obviously at a macro level, these collective steps also help to elevate the aggregate health of the nation’s population with the goal of creating a more healthy and productive workforce.

In general, the focus of these efforts is simply to strive toward connecting doctors to patients anywhere at any time using voice, video, storage, analytics and other technologies over broadband networks to provide consistent, high-quality care to patients regardless if they are two feet away from a doctor in his or her office or 2,000 miles away.

However, in order to facilitate a useful broadband healthcare network, it should support far in excess of the FCC’s current minimum residential broadband definition of 4Mbps download and 1Mbps upload speeds. While these may be sufficient for a residential user streaming a movie or doing a Skype video call with a family member, they do not provide the level of bandwidth needed for a quality telehealth experience. A high-capacity network is essential to support high-definition imaging and video along with high-speed document transfer and voice service – which is why ARRA provided a separate allocation of $7.1 billion for construction of broadband services.

In response to ARRA, the FCC developed a broadband plan that requires community anchor institutions, including education, public safety, government and healthcare facilities, to have access to affordable 1Gbps service. This plan mandates a kind of national network with these wired “hot spots” in key institutions serving the public; the resulting “backbone” promises economic return through community access to many services, including quality healthcare, regardless of their residential location. 

The Backbone of Telehealth

Establishing these telehealth systems is not as simple as connecting computers to telephone lines. In order to deliver on the promise of high-capacity broadband service and all it offers to community anchors, upgrades are required to the network backbone and its extensions into different regions, communities and anchor institutions. Here are three necessary actions that must be inspected to ensure successful telehealth adoption:

1. Fiber optic backbones may need to be upgraded or installed to meet high-capacity requirements;

2. Wireless equipment needs to be installed in areas where existing cellular service may have limited or no coverage;

3. 

Information switching and transport systems need to be modernized to carry multiple types of service (voice, video, imaging, data, etc.)

All of the requirements are quite achievable, given that optical transport systems now operate at rates of up to 100 gigabits per second and Ethernet switching provides a means to aggregate, steer and manage traffic generated by EHR, PACS imaging, high-definition video, voice and any other application. In addition, WiFi and microwave provide reliable wireless network extensions as needed.

Together these technologies provide the foundation for a powerful nationwide telehealth network that, when combined with government funding and initiatives, will provide a solution to the “geographic divide” in national healthcare access and patient care.