Expert Opinion

Craig Settles and Sean Gonsalves: Telehealth For All is a ‘Stroke of Genius’

Without access to a secure broadband connection, the co-author of this Expert Opinion would have died.

Published

2 years ago

March 9, 2022

Broadband Breakfast Staff

Craig Settles (left) and Sean Gonsalves are the authors of this Expert Opinion.

My colleague Craig Settles likes to say he had a “stroke of genius” when writing his last book about building the gigabit city. “I literally had an ischemic stroke at 10:30 p.m. on a Saturday night,” he recalls. “If I had been in a low-income urban community with poor communication infrastructure, or in a rural area with bad broadband, I’d probably be dead.”

The “genius” part was realizing broadband is magic that directly or indirectly enables us to perform minor and major miracles that we could not do before, but faster and easier.

When Craig moved to Alameda, California, situated less than five miles from the heart of Silicon Valley, he could not get cell service without a signal booster, and even then it was sketchy. Several years later the service was better, which allowed him to speed-dial his best friend who called 9-1-1.

The neurologist who set up the stroke center in Alameda Hospital had mirrored much of its technology and servers in her home so she could see everything the ER staff was seeing as they administered life-saving procedures within 25 minutes of Craig’s gurney hitting the ER door.

While Craig counts his blessings, over 14 million urban households do not have broadband in their home – 75 percent of whom are African American and other people of color. Millions more technically have home Internet service but don’t have the connection speeds and capacity to use the applications needed for remote work and school, or telehealth.

And don’t forget the 4 million rural homes that do not have broadband subscriptions.

Broadband as Social Determinant of Health

The essential nature of broadband came to the fore with the onset of the pandemic. And it compelled states and local communities across the nation to take the connectivity crisis far more seriously, especially with the influx of federal funds from the American Rescue Plan Act and the Infrastructure Investment and Jobs Act.

Although advocates commonly, and understandably, tout the importance of broadband access in the context of remote work and schooling, what often gets overlooked are the transformative powers of telehealth and its potential to drive broadband adoption.

It’s no exaggeration to say that broadband is a major social determinant of individual health as it enables access to virtual healthcare and facilitates a host of other things critical to health, such as education, employment, housing, and social services, all of which require broadband, most especially for telehealth applications.

More than video chats with your doctor, telehealth uses high-speed Internet connectivity to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care. Public health, in particular, can leverage telehealth to a great advantage.

Yes, healthcare providers are increasingly integrating telehealth into the delivery of care. But, if the patients most in need of better access to healthcare do not have access to broadband, as well as computing devices and digital skills, tremendous healthcare benefits and cost-savings will be needlessly missed.

This suggests that “fiscally conservative” elected officials, many of whom claim to support universal access to broadband while lamenting the high cost of healthcare, have been thinking about this whole thing backwards. Instead of wailing about the cost of building universal robust broadband infrastructure that could be used for telehealth, why not flip the script?

Achieving universal broadband infrastructure that would last a lifetime would cost on the order of $100 billion, which is just two and a half percent of what we spend on healthcare in this country every single year. Hundreds of academic and industry studies say that even the most conservative telehealth initiatives save more than two and a half percent of system costs.

Talk about a return-on-investment! A hint of this can be seen in a study done by the National Center for Biotechnology Information which found there were as many as 3.5 million potential preventable adult inpatient hospital stays in 2017 alone. That amounted to $33.7 billion in health care costs just for that year.

Telehealth can eliminate many of those stays. And in terms of improving health outcomes, the study further found that the elderly, men, Black communities, and those insured with Medicaid would reap the biggest benefits.

So why not exploit the math, and pay for broadband using healthcare savings? Let’s connect every home, hospital, and community anchor institution in the country to robust broadband, and transform healthcare while bringing it into the 21st century. The municipal broadband model in which local communities build and own the infrastructure is ideal.

Telehealth Can Drive Broadband Adoption

Looking at it this way, universal access to telehealth has the potential to simultaneously solve the connectivity crisis and ensure that millions of families can lead healthier lives.

Here are six tactical ways of using telehealth to maximize public health in a community along with increasing broadband adoption.

Re-inventing the doctor’s office visit for a variety of healthcare practices

Understanding telehealth, all you need are four walls, an Internet connection, a computer, a healthcare partner, and a healthy imagination to create a range of practical telehealth solutions.

Transform barbershops and hair salons into Covid vaccination and hypertension screening centers. The school nurse’s office can now become school telehealth centers. Libraries are starting to add telehealth kiosks.

Libraries Without Borders uses interactive Web health content, laptops, and wireless gear to outfit intercity laundromats on Saturdays. Tucson used ARPA funds to build out a wireless network on top of the city’s fiber infrastructure and gave 5,000 low-income homes the ability to have telehealth resources.

Telehealth can marry chronic healthcare, home care, and public health

Frederick Memorial now distributes hundreds of tablet computers for remote patient monitoring in patients homes to check their vital signs, changing medical conditions and treatments, with data that goes to the hospital daily.

Urban hospitals should partner with ISPs to leverage the FCC’s Affordable Connectivity Program subsidy of up to $30 per month for Internet service and up to $75/month for households on Tribal lands. ACP also offers a $100 discount on computing devices.

Enhance the emergency response and Emergency Department to save more lives and money.

African Americans and other populations of color have the highest rates of strokes, heart attacks, and other medical trauma. We could reverse the trend of hospitals that abandon poor urban communities and replace them with city telestroke or telehealth critical care “broadband subnetworks” that are hosted by major hospitals and linked to Federally Qualified Health Center, clinics, and other facilities.

Expand efficiency of mental healthcare delivery

Mental health professionals getting to see patients in their homes and therefore providing an alternative to needing to go to a therapist’s office can not only eliminate no-show appointments but can provide those most in need of therapy with broader access to a variety of specialists.

Leveraging telehealth can be especially empowering for underserved communities in which approximately 30% of African American adults with mental illness receive treatment each year, compared to the U.S. average of 43%, according to the National Alliance on Mental Illness.

But as Carly McCord, Director of Clinical Services at the Texas A&M Telehealth Counseling Clinic, rightly points out: “Often we’re talking about intensive therapy, like treating PTSD, which you can’t do with crappy Internet connections. When your patient’s disclosing a trauma and your connection glitches, or you miss a word and have to say, ‘I’m sorry. Can you repeat that? ‘This is a huge problem.”

Improving senior care and facilitating aging in place for our nearly 60 million seniors

Three-in-four older Americans want to stay in their homes and age in place, according to a AARP survey. And, if offered a choice, about 53 percent of respondents say they would prefer to have their health care needs managed by a mix of medical staff and healthcare technology.

A key broadband element in this telehealth equation is “smart home” technologies that include wirelessly-controlled sensors. Some sensors now can determine whether a person sat up in bed or actually fell on the floor, if patients are eating regularly, or if they are taking their medications on time.

Re-imagining what hospital care can be

In areas prone to natural disasters, make prior arrangements with hotels, college dorms, warehouses, and other facilities where you can bring in generators, computers, telehealth equipment, and wireless intranets.

Use these buildings for seniors with health conditions who have been displaced: people with chronic illnesses and patients with non-serious injuries from the disaster should those people not have easy access to other residential or healthcare facilities.

Building and subsidizing access to robust community-owned broadband networks is a wise investment because it will improve health outcomes and return significant community savings for decades to come.

And with a flood of federal funds available to build broadband infrastructure and advance digital equity, we have a once-in-a-life opportunity to stitch this all together and deliver telehealth for all.

Sean Gonsalves is a Senior Reporter, Editor and Communication Team Lead for the Institute for Local Self Reliance’s Community Broadband Networks Initiative. Saved from a stroke by telehealth, Craig Settles pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth-broadband integration initiatives. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

Up Next

Michael Jones: Maps and Data Analysis are the Keys to Effectively Targeting Broadband Subsidies

Don't Miss

‘Ample Evidence’ Telehealth Contributed to National Covid Response: FCC Commissioner Starks

Broadband Breakfast Staff

Broadband Breakfast is a decade-old news organization based in Washington that is building a community of interest around broadband policy and internet technology, with a particular focus on better broadband infrastructure, the politics of privacy and the regulation of social media. Learn more about Broadband Breakfast.

Click to comment

Expert Opinion

Craig Settles: Believe in the Healing Power of Telehealth

Healthcare organizations are seeing telehealth as an opportunity to enhance connectivity with patients and improve healthcare outcomes.

Published

3 weeks ago

August 28, 2023

Craig Settles

The author of this Expert Opinion is Craig Settles, who unites community broadband teams and healthcare stakeholders through telehealth

Listening to many politicians and National Telecommunications and Information Administration officials, you’d think “broadband” is practically synonymous with “telehealth.” So let’s go with it! Make telehealth front and center, the marketing hook of your NTIA Broadband Equity Access Deployment and Digital Equity Act grant applications.

Do a medical needs assessment of NTIA’s eight populations (target markets): 1) low-income urban dwellers, 2) rural communities, 3) Native American communities 4) veterans, 5) seniors, 6) people with disabilities, 7) those for whom English is a second language, and 8) the incarcerated. Low-income Americans have high rates of heart disease, diabetes, stroke, and other chronic conditions compared to higher-income Americans.

How many people would we help with telehealth and how many people would go home with a computing device? A marketing win-win – attack the disease, attack the digital divide.

By the numbers

The Centers for Disease Control and Prevention reports 4 of 10 adults live with two or more chronic diseases. That’s 103.2 adult human beings. Imagine if we leveraged those $45 billions from NTIA, the thousands of all staff people, and the hosts of volunteers to treat, cure, or prevent chronic conditions?

In 2020, 1,603,844 new cancer cases were reported and 602,347 people died. About 695,000 people in the U.S. died from heart disease in 2021 and the disease costs us about $239.9 billion each year in 2018 and 2019. 37.3 million people have diabetes.

Many more millions suffer from and die from lung disease, strokes, Alzheimer’s disease, obesity, and kidney disease. What’s more, many these of chronic diseases are driven by unhealthy lifestyles – smoking, minimal physical activity, poor nutrition, and excessive alcohol use.

Make sure the numbers include the dramatic disparities. For example, African Americans make up 12% of the U.S. population, but twice as many die from strokes (100,000) as all other ethnic groups combined. Studies have found that Black people between the ages of 45 and 54 die of strokes at a rate that’s 3 times greater than their White counterparts. Being overweight or obese increases your risk of stroke. About three out of four Hispanics are overweight.

Telehealth making a difference: Gilda Radner’s legacy

Gilda’s Club Twin Cities, part of the Cancer Support Community global non-profit network providing free social and emotional support for those impacted by cancer, offers telehealth to medically underserved Minnesota urban and rural residents. The club partnered with telehealth firm Equiva and ISP Infinti Mobile to enroll members in the Federal Communications Commission’s Affordable Connectivity Program, to sign them up for Internet access, and send them tablets preloaded with special content.

“CSC organizes the telehealth content in a way that makes sense for their constituents,” says Beth Strohbusch, head of marketing for Equiva. “Members learn about cancer treatment options, digital support groups, and free psychosocial services if members are having problems with depression.”

Strohbusch believes it’s not just hospitals and support groups pursuing broadband and telehealth. Healthcare organizations, nursing homes, and financial risk-bearing organizations are seeing telehealth as an opportunity to enhance connectivity with patients and improve organizations’ financial and chronic healthcare outcomes.

Jason Welch, Infiniti president, says, “Equiva has a reach we don’t have – the healthcare communities, the cancer support community, those in elder care, the larger healthcare organizations. Infiniti saw a natural, practical fit. The Equiva ACP Connect Program is a practical combination of services that are easily explained. Our customers understand accessing healthcare and related resources from their computers and is the data transport mechanism allowing them to do so.”

The eyes have it

Age-related macular degeneration affects the central part of the retina that allows you to see fine details clearly. AMD causes damage to the macula and results in blurring of your central vision. It is a leading cause of blindness among older Americans and is more common in individuals of European ancestry.

Ocutrx manufactures an augmented reality corrective devices that tackles AMD and doubles as patients’ cell phone with Wi Fi, 4G, and 5G capabilities. CEO Michael Freeman says, “We build circuit board in our headsets that enables them to do everything that cell phones do, control seven cameras, and creates the six degrees of freedom where patients can pose virtual objects out in front of their eyes.”

The user puts on the headset and continually does a field test in each eye. Software signals the device when the user can’t clearly see an object, which triggers the cameras that starts projecting real-time on the lens a live 60-frames/second video. Augmented reality moves pixels from the peripheral to the front of the user and within 13 milliseconds the user can see the object.

Ocutrx has a headset for patients with chronic disease. Patients and their doctor each has a headset and cell phone capabilities for talking real time over an encrypted network. This headset measures temperature, respiratory rate, heart rate and other readings. Freeman adds, “Its camera can be disconnected so you can show the doctor your arm or leg.” To treat ‘lazy eye’, AI in the headset let’s patients play a game virtually. It frosts the lens of the good eye and makes the lazy eye work harder and tracks how well the eyes work together when they’re doing the exercises.

The fruits of telehealth

Telehealth vender Fruit Street delivers digital therapeutics for addressing bad habits that have medical consequences. CEO Laurence Girard says, “digital therapeutics may be programs that deal with sleep, stress, and resiliency, others may focus on opiate addiction or general mental health.

One in three adults have prediabetes in which someone’s blood glucose (sugar) level is too high but not high enough yet for a diagnosis of type 2 diabetes. Fruit Street’s Digital Diabetes Prevention Program combines group telehealth sessions, wearable devices, and dietary tracking in the vender’s mobile application. Besides lowering the risk to develop type 2 diabetes, the program can also lower the risk of having a heart attack or stroke, improve health overall, and help subscribers feel more energetic.

Consider nonprofits marketing core digital therapeutics within a community. Imagine teams of “Life Changers” whose main goal is to embed broadband, smart home, cloud, and telehealth infrastructure that keeps residents healthy while reducing asthma, diabetes, hypertension, and other chronic illnesses.

Craig Settles conducts needs analyses with community stakeholders who want broadband networks to improve economic development, healthcare, education and local government. He hosts the radio talk show Gigabit Nation, and is Director of Communities United for Broadband, a national grass roots effort to assist communities launching their networks. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

Expert Opinion

Kristian Stout: Red Tape and Headaches Plague BEAD Rollout

States must overcome numerous hurdles before BEAD will be able to succeed.

Published

1 month ago

August 18, 2023

Broadband Breakfast Staff

The author of this Expert Opinion is Kristrian Stout, director of innovation policy at the International Center for Law and Economics

As part of the $1.2 trillion Infrastructure Investment and Jobs Act that President Joe Biden signed in November 2021, Congress allocated $42.45 billion to create the Broadband Equity Access and Deployment program, a moonshot effort to close what has been called the “digital divide.” Alas, BEAD’s tumultuous kickoff is a vivid example of how federal plans can sometimes become a tangled web, impeding the very progress they set out to champion.

In the weeks since the BEAD initiative was rolled out by the National Telecommunications and Information Administration, state officials have been voicing mounting concerns over what they see as bureaucratic roadblocks to implementation. Tamarah Holmes, director of Virginia’s Office of Broadband, recently called BEAD “the most burdensome federal program” she’s ever encountered. Given that she previously worked for the U.S. Department of Housing and Urban Development, an entity notorious for extensive bureaucracy, that’s saying something.

One frequently cited problem has been NTIA’s preference for fiber-optic connections, which finds itself in tension with realities on the ground. While fiber connections often provide the best solution, implementing them can be challenging in rough terrain and remote areas. Other technologies like fixed wireless and satellite often make better sense in such territories. Here, the one-size-fits-all approach that NTIA has preferred is proving detrimental to a more tailored, location-based strategy.

This should not be news to NTIA. As Sen. John Thune, R-S.D., and his colleagues noted in April, states must overcome numberous hurdles before BEAD will be able to succeed—from labor stipulations that are more prescriptive than inclusive to the program’s inexplicable favoritism for government networks over private enterprises. Coupled with requirements like the middle-class affordability option, which will essentially function as a form of rate regulation, the entire implementation push has been creaking under the weight of its own red tape.

In its initial notice of funding opportunity, NTIA also required a preference for noncontract labor when an internet service provider rolls out a network. Unfortunately, there are not nearly enough fiber-optic technicians available in the United States to keep up with the demand created by BEAD. Thus, creating impediments to quickly bringing technicians online only saddles the program with further costly problems.

So, where does this leave America’s ambitions of broadband equity and access?

For one, there’s a compelling need to reassess the BEAD initiative’s guiding principles. The rigidity that’s currently the program’s hallmark needs to be replaced with adaptability. Each state, with its unique geography and challenges, should be given the flexibility to chart its own digital course. The federal role should be that of facilitator, not gatekeeper or, worse still, roadblock.

Moreover, implementation should be guided by a principle of technological neutrality; preferences for particular technologies simply do not make sense. Above all, realities on the ground must shape deployment strategies, not overarching directives that may be disconnected from the local context. The impending workforce challenges must also be addressed proactively. The most obvious solution would be to remove requirements that frustrate the onboarding of technicians as expeditiously as possible.

America’s broadband aspirations will only be realized through a commitment to adaptability and putting the demands of reality ahead of political preferences.

Kristian Stout is the director of innovation policy at the International Center for Law and Economics. This piece is exclusive to Broadband Breakfast.

Expert Opinion

Scott Sampson: How Fiber Can Build a Work Culture in a Remote World

Greater reliable and secure broadband bandwidth is necessary to support a quality remote culture and work environment.

Published

1 month ago

August 15, 2023

Broadband Breakfast Staff

The author of this Expert Opinion is Scott Sampson, CEO of Fiber Fast Homes

With the increased popularity of working remotely, organizations are being challenged to create and maintain a positive culture in a virtual environment. While elements of creating a strong, collaborative work culture have not changed, technology has taken on a more vital role during the surge in remote work.

A core necessity needed to support remote workers is high-speed Internet connectivity. Remote workers count on their Internet service provider to deliver the connectivity needed to keep up with and manage the applications required to have a successful workday in a remote environment. Fiber Internet is the best solution to provide the “enterprise-level” performance and reliability needed to support this paradigm shift.

Why is a strong remote work culture important and what are best practices?

Just like the work culture in the office, there are many benefits to developing a work culture that considers the remote nature of the environment:

A strong and consistent remote work culture can unite employees and give them a shared sense of purpose.
Remote work culture prepares organizations for future success.
Remote work culture can build long-term relationships using the right environment.

Since the pandemic, companies have been working hard to create a remote work culture and a lot of best practices are coming out of that work:

Create an environment of trust — To create a healthy remote work company culture, it’s important to communicate all the high-level decisions with teams to show employees that they are trusted completely to manage their work and are not being left out of the conversation just because they are not in the office.
Share the company’s mission and goals — Creating an optimum and high performing remote teamwork culture becomes easier when everyone understands the mission and goals an organization is trying to achieve. It can work as a constant reminder for employees to always know what they are trying to accomplish as a team.
Define the company’s remote work policy — Remote work or flexible work can mean different things to different people. As a result, a company needs to be as specific as possible about the organization’s remote work policy so the employees know exactly what to expect. More clarity will only lead to smoother remote work and better culture.
Make face-to-face meetings a priority — While there is no replacement to meeting your team members directly, regular video calls can help close the communication gap. Team managers should hold regular one-on-one meetings with employees to build better connections, establish trust, and celebrate their individual accomplishments. Another simple thing — encourage team members to switch on their video during team meetings. Face-to-face communication helps workers get to know each other in a better way.
Collect regular feedback and make changes accordingly — It is always a good idea to ask remote employees for their feedback regularly so that they can tell you what’s working for them and what just isn’t. Many are new to the remote work culture so feedback is invaluable.
Use the right tools — The long-term success of remote work also depends on whether you’re using the right tools to manage work. Such things as video conferencing, a digital workplace platform for collaboration, or instant messaging are essential to supporting the remote culture workers’ needs. Having the right tools makes a difference, but just as important is having high performing bandwidth to make those tools perform optimally.

Broadband connectivity is the technological backbone for building a remote culture

All kinds of technology tools are popping up to better support the remote worker from online video conferencing to digital workplaces to cloud-based data management tools. As a result, greater broadband bandwidth that is reliable and secure is necessary to support the delivery of a quality remote culture and work environment. There are four reasons why:

Performance Needs to Be Comparable to That in the Office – Just because one is remote doesn’t mean poorer network performance than the enterprise is okay. Companies are demanding commercial grade Internet performance at home, too.
Remote Enterprise Applications Demand More Bandwidth — New, advanced applications requiring greater network speeds that could only be available at the office need to be attainable by remote workers.
Scalability Is Paramount — Broadband connectivity needs to be able to scale as more remote workers require access and applications require greater bandwidth and performance.
To Duplicate In-Person Culture, Bandwidth Needs to Do More — Bandwidth needs to be fast enough to support technologies that can more closely duplicate in-person culture, such as AI, real-time interactive streaming, and human resources applications that analyze unique types of data about the employee experience and interaction, often in real time.

While technological innovations will continue to change and improve the cultural experience for an organization regardless of where an employee works, the demand for higher performing, more reliable, and more secure bandwidth will be needed. Fiber is the only technology that can meet these demands today and scale to meet even greater demands in the future.

Scott Sampson is an experience executive with extensive knowledge in all aspects of telecommunications and IT and is one of the industry’s leading experts on fiber to the home. He has worked with companies such as Arrow Electronics, ULA, and Rio Tinto, as well as a successful sale of a company he co-founded. Sampson is known for building high-achieving teams. This piece is exclusive to Broadband Breakfast.