Vermont Looks To Bring Oasis of Fiber-Connected Telehealth Hubs to ‘Healthcare Deserts’

Many rural healthcare facilities are struggling to keep their doors open. Some have been shuttered. Add to that the looming federal budget crisis threatening to end Medicare payments for telehealth and the urgency of what a coalition of Vermont healthcare leaders, librarians, and state broadband officials are doing comes into view. 

It’s called VITAL VT (Virtual Integration for Telehealth Access through Libraries in Vermont) – an exploratory effort being launched with a $10,000 grant from the Leahy Institute For Rural Partnerships, working in collaboration with the University of Vermont Medical Center and the Vermont Library Association.

The aim is to leverage the state’s unprecedented deployment of community-owned fiber networks and create a scalable, community-centered telehealth model. 

“We’re really looking to find any way to make any of our community members in Vermont get access to care – easier, better, quicker. So we’re wondering if telehealth (hubs) might be the right answer for that, if we’re able to put it right in people’s libraries, right in their own towns,” Roz King, chief of research for emergency medicine at the University of Vermont, told local CBS affiliate WCAX.

Data-mapping ‘Healthcare Deserts’

In speaking with ILSR this week, King said what spurred the initiative was a talk given by one of UVM’s medical students who noted how Vermont was beginning to see “healthcare deserts where in some rural counties PCP’s were aging out and no one was there to provide healthcare (services).”

But with the state’s aggressive expansion of fiber networks via Vermont’s Communications Union Districts (CUDs), it is now becoming possible to provide widespread telehealth access, which has been shown to improve health outcomes (especially for those with chronic health conditions), facilitate aging-in-place, and offer residents significant cost and time savings.

Or as King tells ILSR, telehealth can provide significant benefits in terms of preventative medical care and has the potential to “lower copays and bills and reduce other burdens like transportation costs, gas money, time off work, and childcare. Those are things we are looking to alleviate.”

King said UVM decided to apply for a small grant to get started because “what’s nice about small grants is it gives us the autonomy to figure it out. Often with large grants you have to go all in (with a single detailed approach), but with the generosity of the Leahy Institute we can take a more measured approach and spend the next year doing needs assessments in communities, with healthcare providers and libraries.”

Libraries became a focal point because most Vermonters, even those residing in small rural communities, live close to a library. “We still need to determine how many libraries have the computers, private spaces, what their hours of operation are, or if they have WiFi in the parking lot," King said.

"Once we complete the needs assessments, we hope to pick one or two sites to pilot this next year.”

‘It has to be fiber’

None of this would be possible, however, without the only telecommunication infrastructure capable of delivering telehealth at scale: Fiber networks.

Enter the Vermont Community Broadband Board (VCBB), the state’s broadband office administering the grant programs fueling the fiber-to-the-home boom now underway across the state’s nine CUDs.

As recently as 2019, the Vermont Department of Public Service found that a quarter of the state’s residents couldn’t get even basic service. After the CUDs get done building, all of those locations – and more – will have future-proof fiber connections.

It’s all possible because the state had the forethought to leverage an historic influx of federal funds courtesy of the American Rescue Plan Act and pending infrastructure law dollars. And not only is it bringing high-speed Internet to areas long left in the lurch, it also highlights the nexus between modern telecommunication infrastructure and something that touches everyone’s life: access to healthcare.

“This (VITAL VT initiative) is an entry point. But, if you look at it – the bandwidth and reliability that’s needed – it has to be fiber,” VCCB Executive Director Christine Halquist tells ILSR. “Why fiber? Because of its low latency, it’s very reliable, and can handle lots of data.”

It’s also why the VCBB is supporting the initiative through its “Digital Empowerment Program” and by tapping its statewide human network rooted in the state’s CUDs.

“The districts have representatives from each town. Because of this model, we got involved,” noted VCBB Deputy Director Robert Fish, emphasizing how increasing fiber access is “a first step to more advanced capabilities.”

Acknowledging the hotly debated role of LEO satellite Internet service (Starlink and Amazon’s Kuiper), Fish said, "this is not something Starlink (LEO satellite) can do. With fiber you have redundancy, whereas with Starlink there is a single point of failure. It's susceptible to solar flares (and other hazards). What happens if an entire region goes out for something as important as telehealth? How long would it take to replace the satellites? What’s the lifecycle? It’s one of the reasons we are so focused on fiber.”

(Read ILSR's brief on why we think the federal BEAD program should continue to prioritize fiber Internet network investments here.)

‘Future-proofing’ healthcare

Now that the fiber infrastructure is being built, Halquist and Fish see an enticing possible future.

“The greatest potential,” Halquist said, would be having (Internet-connected) devices sending real-time information to healthcare providers. “Think about an aging population who may have heart issues. AI data could be used to do what – in the computer world – we call predictive failure. We can now do that with humans in real time…where an alarm goes to your care provider and a potential problem can be addressed before needing to come for an ER visit.”

“This technology is moving in this accelerated positive direction” and while having the technology and infrastructure in place is fundamental, Halquist said, it was just as important to ensure that programs like Medicare cover telehealth visits, which is now threatened to be cut if Congress doesn’t act by the end of this month.

“Our job is not done when we get everyone connected. Our job is to maximize the positive social impact of these investments,” said Halquist, who recently published an op-ed on how ‘telehealth can transform health care in Vermont.’”

Fish shares that vision, one in which telehealth helps lower health care costs, improve health outcomes, and extends real human connection.

“With telehealth, you can have your family there for support – even if they're across the country. That’s possible now.”

Still, even as Vermont is committed to making telehealth widely available across the state, there’s crucial legislative work that will be required to ensure healthcare providers and residents can maximize its potential.

“There’s so much that is still a gray area around regulations that were loosened around the pandemic” King said – rules that would need to be expanded and made permanent to pave the way for insurers and especially Medicare to pay for telehealth appointments.

Watch the award-winning short documentary “Connected,” which tells the story of Vermont's grassroots effort to bring broadband to its rural communities, below:

This article was published by the Community Broadband Networks Initiative of the Institute for Local Self Reliance on CommunityNets on March 13, 2025, and is reprinted with permission.