Craig Settles: Hospital at Home Telehealth Can Drive Broadband Adoption

The handwriting is on the wall: Hospital at Home, telehealth and wireless can drive broadband adoption substantially.

More than 400 communities, many of them rural, are benefiting from these three technologies. Communities wanting to advance broadband equity, healthcare equity, and increase digital inclusion in general, fixed wireless in particular should high in the mix.

“Hospital at Home is what it sounds like - we are taking care of patients at home who would otherwise be in an acute inpatient hospital bed,” says John Campbell, Chief Information Officer and Healthcare at Home for Mass General Brigham, largest health services provider in Massachusetts.

“Services include remote patient monitoring, twice daily in-person visits from nurses and paramedics, daily video visits from physicians, medical equipment plus laboratory, pharmacy, and radiology services. These operations are driven almost entirely by wireless.”

Telehealth (including Hospital at Home) is the ‘magic app’ for broadband

Everybody gets sick at some point, or they are responsible for others who are sick. Like telehealth, Hospital at Home can’t function well when patients and doctors don’t have access to reliable and affordable broadband.

Everyone needs Internet access and the unserved and underserved need it most of all. There are quite a few sources of money for building broadband networks that deliver high-speed Internet. However, barriers to getting Internet access and computing devices deployed can be daunting. 

The universal need for telehealth and broadband should point to urban and rural communities creating a roadmap that unites these symbiotic technologies. A perfect storm is brewing. Communities are learning lessons from COVID-19

Boston built a 1000-bed fully operational hospital facility – called Boston Hope – in only seven days in April 2020? Even more miraculous was moving 10,000 physicians en masse to telehealth within a few weeks. 

“Boston Hope was connected to Boston Hospital’s fiber backhaul, but wireless absolutely played a big role in our being able to roll out telehealth quickly and broadly in a way that would have been prohibitive in a wired world because wired is too constraining,” says Campbell. Wireless allowed the staff to do many medical tasks and hospital administration because many things in Boston Hospital already depended on wireless. 

Hospitals at Home: The digital divide rears its ugly head

The beautiful thing about Hospitals at Home is that it takes the field hospital concept like Boston Hope, refines the medical services, moves it into people’s homes, and adds in a mobility element of full-blown clinics-on-wheels. Growing the number of programs to over 400 has given the concept validity, market exposure and a track record of success.  

The cloud over these programs is that the rich get richer, and the poor get poorer services. Currently the wireless is mostly cellular networks, such AT&T, Verizon, and T-Mobile. As programs want to add more medical services that require more broadband capacity and speed, that means network upgrades. But without question, more affluent areas are prioritized for upgrades such as 5G.  

The incumbents are a disincentive to improved services for poor communities. They are monopolistic in their behavior, and they kill competition that can lead to lower prices. Campbell says, “The broadband services in these communities are subpar, and to me, there really haven’t been a lot of economic programs that make broadband more accessible to folks. Luckily, that’s changing a little.”

Hospitals at Home can benefit service for low income, unserved and underserved populations if communities in their planning incorporate 1) fixed wireless competitively bid, 2) federal/state broadband AND health grant programs, and 3) service providers that partner with local jurisdictions.

Who can see the vision?

Dwayne Zimmerman, CEO for Crowsnest Broadband, a rural WISP, says, “We're selling one manufacture’s first-generation product that delivers 300 Meg download, 100 Meg upload. Each radio attached to a tower has seven or eight gigabits of aggregate capacity per radio. You can put four or eight of them up on a tower. We've got 100 gig, 40 gig, 25 gig backbone and 10 Gig transport circuits.” This is high capacity for rural medical care-related applications.

And the people who connect the networks? “WISPs are scrappy entrepreneurs who have built networks on shoestring budgets,” says Zimmerman. “10, 15 years ago when most of them started had a vision to get Internet into rural communities. They learned by doing, they’re fast, efficient, and they’re working with top-of-the-line equipment.” In rural areas, Hospitals at Home is challenged by the lack of broadband. WISPs and smaller ISPs should make the grade.

Cleveland, Ohio residents have a Hospital at Home, which "we believe is the future of medicine,” said MetroHealth President and CEO Akram Boutros, MD, FACHE in a press release. “This will allow us to greatly expand the program that we recently implemented to provide great care to our patients in the comfort of their own homes.” MetroHealth, one of the largest hospitals in the city, launched a new program in November 2023 to provide care for patients living with sickle cell disease.

DigitalC, a Cleveland WISP, beat out AT&T, Spectrum, and T-Mobile to win a city broadband grant to build a fixed wireless network that will cover up to 170,000 residents 100 megs symmetrical speed for $18 a month. DigitalC has an existing partnership with MetroHealth.

“They view us a vital lifeline or entry point into a household and will pay to subsidize connections of their patients on the network,” says Joshua Edmonds, DigitalC’s CEO. “We will walk our customers through how to enroll in their MyChart patient portal and create a profile.” As the network expands and Hospitals at Home increased services, patients will have tighter relationships with their doctors and healthcare providers, DigitalC will have tighter relationships with subscribers.

Craig Settles assists cities and co-ops with business planning for broadband, as well as showing how telehealth can drive broadband adoption. He released in December a position paper titled “Be All You Can BEAD.” It’s a short document that presents many interviews with industry executives explaining how (1) wireless is future proof in its own right, (2) how we can combine wireless and fiber to be greater than the sum of the parts; and (3) why BEAD policy needs to reflect common sense and good judgment. This Expert Opinion is exclusive to Broadband Breakfast.

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