A growing patient population, a shrinking doctor pool. This is not an ideal set of circumstances, but it is reality for the dialysis industry. Could telemedicine be part of the solution? According to leaders at the Federal Communications Commission, possibly. On July 15, 2010, the FCC introduced a new healthcare connectivity program to expand investment in broadband for medically underserved communities across the country. The purpose of the program is to give patients in rural areas access to state-ofthe- art diagnostic tools that are usually only available in large and wealthy medical centers.
The proposals include:
- Partner with public and nonprofit healthcare providers to invest millions in new regional and statewide broadband networks in parts of the country where it is unavailable or insufficient. The new program aims to build cost-effective broadband networks—connecting doctors, hospitals and clinics.
- Making broadband connectivity more affordable by sharing half of the monthly recurring network costs with hospitals, clinics and other healthcare providers. This enhanced support for broadband connectivity may benefit patients served by thousands of public and non-profit rural healthcare providers.
- Delivering connectivity where it is needed most, including skilled nursing facilities and dialysis centers, along with off-site administrative offices and data center that perform support functions critical to healthcare networks.
The program’s investment in broadband connectivity would not only improve medical care, but also help reduce healthcare costs, the FCC stated in a news release. "It would spur private investment in networks as well as health-related applications, and would help create jobs that range from building infrastructure to developing and implementing health IT solutions," it continued. "This program has the potential to do for rural healthcare providers and patients what the enormously successful E-Rate program has done for schools and students."
Right now, a great many healthcare campuses lack affordable access to even the basic broadband connectivity that is necessary handle tasks such as managing medical records, transmitting diagnostic results, or hosting a remote meeting, according to the FCC. Nearly 30 percent of federally funded rural healthcare clinics can’t afford secure and reliable broadband services, the agency claims. "Shockingly, only eight percent of Indian Health Service providers even have access to the broadband they would need to deliver advanced healthcare to their patients," according to the FCC release.
The program would invest up to $400 million annually with the intention of helping doctors, nurses, hospitals and clinics deliver high-quality healthcare to patients no matter where they live. It is one of four programs in the Universal Service Fund administered by the FCC. Without increasing the projected size of the overall fund, the Notice of Proposed Rulemaking would bring affordable broadband connectivity to more than 2,000 rural hospitals and clinics.
The State of California is not waiting for federal intervention. On Aug. 17, 2010, Gov. Arnold Schwarzenegger and U.S. Chief Technology Officer Aneesh Chopra joined leaders of statewide healthcare and technology agencies at the UC Davis Cancer Center in Sacramento to launch the California Telehealth Network (CTN). Officials said the California Telehealth Network is the largest single-state grant award of its kind, connecting more than 800 California healthcare facilities to a statewide medicalgrade network of healthcare and emergency services.
"Our passion for broadband and healthcare is tangible and real and will have a big impact here in California," Chopra said during the announcement. "The CTN network will provide both the traditional and advanced IT infrastructure that telemedicine needs for growth."
The network is the result of a $30 million joint funding effort between the Federal Communications Commission (FCC), the California Emerging Technology Fund (CETF), the California HealthCare Foundation, UnitedHealthcare, the National Coalition for Healthcare Integration, the University of California and other private and public entities, according to a California Telehealth Network press release.
By bringing broadband capacity to those in need, CTN is empowering individuals to take more responsibility for their own health, said Sunne Wright McPeak, president and CEO of California Emerging Technology Fund. "We're proud to be a partner in the effort to build a robust statewide network that will bring specialized health and medical care to underserved communities, both rural and urban," she said.
Currently 12 million Californians are still not connected in their homes, according to McPeak, who predicts that access will quickly improve their healthcare regime. She also expects that telehealth will reduce the cost of follow-up care by 40 percent, and reduce overall cost by six percent. At San Joaquin General Hospital, there are six telemedicine initiatives.
The initiatives are:
- Health Care Interpreter Network
- Diabetic Retinopathy Screening (store and forward)
- Teledermatology
- Teleneurology
- Mental Health (juvenile Justice)
- Child Sexual Abuse Exam Monitoring Program
The benefits differ, depending on whether you are a hub or a spoke, according to Jerry Royer, MD, MBA, chief medical officer at San Joaquin General Hospital, in French Camp, Calif. "For spoke sites, specialty care access extends to areas that do not have specialists," Royer said. "Hub sites benefit from referrals. At spoke sites, patients have telemedicine access to specialty care not available in the community. Patients also benefit from referrals to hub sites and their specialists."
Can telehealth be used in dialysis as well? Absolutely, and it's already being done. Telemedicine at the Dialysis Center of Lincoln has allowed staff, nurse practitioners and physicians to interact in a more timely manner, and has bridged the distance gap electronically with sight and sound, according to Larry Emerson, CEO of the Dialysis Center of Lincoln.
There are two rural dialysis units 45 and 80 miles away, which is clearly inconvenient without telemedicine. The technology has allowed patients greater access to healthcare professionals, especially nurse practitioners. Otherwise, travel time is a huge issue. "We even hear that with three units covering a small urban area, telemedicine helps to lessen those costs," Emerson said. "I think the professional staff like the interaction as it makes for better communication and information exchange and thus better decision making. Most patients would rather see the professional in person, I personally would feel that way. But as patients use the technology, their level of comfort improves and creates an opportunity for a good exchange. Even though it doesn’t allow direct touch it allows for a sense of personal attention."
