How Broadband Connectivity Impacts Health Care

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Executive SummaryExecutive Summary

In the 20th century, health care made a long list of advances including the introduction of the polio vaccine in 1954, Computerized Axial Tomography (CAT) scanning in 1975 and Magnetic Resonance Imaging (MRI) in 1983. In the 21st

century, equally impactful advances are being made due in part to broadband-enabled technologies.

The Federal Communications Commission (FCC) has worked for years to support adoption of broadband-enabled health care solutions and the availability of health-related technologies for all Americans. In 2014, the Connect2HealthFCC Task Force was formed with a vision to “get everyone connected to the people, services and information they need to get well and stay healthy.” The Task Force believes better outcomes and lower costs will result when many resources — doctors, social services, nutritionists, pharmacies, caregivers and others — are linked through broadband connections.

This white paper examines some of the key categories of broadband-enabled health care solutions and their advantages for health care providers as well as patients. As a health care provider, you are working at the intersection of communications technology and medical technology. It’s an exciting, yet challenging, time as you navigate your organization’s changing broadband requirements within the parameters of available fiber networks and budget considerations. This can be particularly difficult for hospitals, medical offices or clinics in rural areas with less access to affordable, high-speed broadband.

Now is the time to work closely with your technology partners to make strategic decisions about broadband and other communications solutions. It will take a collaborative effort among many resources to meet the health care needs of Americans today and tomorrow.

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Broadband connectivity is having a profound effect on health care in America. It is opening the door to more accessible and cost-effective patient care through telehealth, speeding the transmittal of electronic health records and digital images, and increasing mobility with wireless monitoring devices.

Introduction/Overview

1 http://www.healthit.gov/providers-professionals/faqs/what-telehealth-how-telehealth-different-telemedicine2 http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Telemedicine.html

3 http://info.imsresearch.com/lz/Instances/lz/documents/InMedica/Brochures/Abstract%20-%20World%20Market%20for%20Telehealth%202014%20Edition.pdf4 http://www.broadbandexpanded.com/policymakerfiles/telemedicine/Telemedicine_Stats&Data.pdf5 http://www.healthcareitnews.com/news/report-more-docs-embracing-ehealth

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Telehealth Includes an Expanding Number of Services

The terms “telehealth,” “telecare” and “telemedicine” are sometimes used interchangeably but there are subtle differences. Telehealth is the broadest of the three terms, used to refer to the provision of health care services, health care education and health information services at a distance using technologies including videoconferencing, the Internet, streaming media and wireless communications. Another technology used in telehealth is store-and-forward imaging, which involves the acquisition and storing of clinical information that is then forwarded to (or retrieved by) another site for clinical evaluation. Telecare and telemedicine are generally encompassed within the overall scope of telehealth.

Definitions and Examples

• Telehealth - The Health Resources Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support longdistance clinical health care, patient and professional health-related education, public health and health administration.” Telehealth includes the clinical services of telemedicine in addition to remote non-clinical services such as provider training, administrative meetings and continuing medical education.1

• Telemedicine - This term refers specifically to the provision of clinical services to patients in other locations. Examples of telemedicine include video consultations with specialists; remote monitoring of blood pressure, ECG or other vital signs; remote medical evaluations and diagnoses; and the digital transmission of medical imaging. Using these technologies, medical practitioners are able to evaluate and diagnose patients remotely, prescribe treatment, e-prescribe medications and quickly detect fluctuations in the patient’s medical condition at home, to be able to alter therapy or medications accordingly.

For purposes of Medicaid, telemedicine seeks to “improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site.”2

• Telecare - Technology that allows patients to stay safe and independent in their own homes is classified as telecare. It uses telecommunications services and monitoring devices — such as warden alarms, automatic gas shut-off devices and home entry videophones — to manage patient risks and track lifestyle changes over time.

Statistics Point to Telehealth Growth

According to IHS Telehealth Report - 2014, the number of patients worldwide using telehealth services is expected to grow from 350,000 patients in 2013 to approximately 7 million by 2018.3 This growth trend is echoed in Broadband & Telemedicine: Stats, Data, & Observations, which gathered these additional statistics.4

89% of health care executives said they expect telemedicine to transform the U.S. health care system in the next decade.

Source: iHealthBeat

The global telemedicine market is expected to grow from $11.6 billion in 2011 to $27.3 billion in 2016.

Source: BCC Research

Telemedicine could potentially deliver more than $6 billion a year in health care savings to U.S. companies.

Source: Towers Watson

The percentage of health care employers offering telemedicine is expected to increase by 68% by next year, from 22% in 2014 to 37% in 2015.

Source: Towers Watson

One reason for this growth is that physicians are becoming increasingly comfortable with telehealth. According to a survey done by PwC, a professional services network, 50 percent of physicians say that telehealth visits could replace more than 10 percent of in-office patient visits.5

Providers Can Increase Care Quality and Reduce Costs

Given the realities of rising expenses, an aging population and the prevalence of chronic diseases, health care providers have their work cut out for them in the years ahead. Using telehealth, including telemedicine, is a viable way to meet these challenges while revolutionizing patient care and reducing overall health care expenditures.

The American Medical Association (AMA) believes that the appropriate use of telemedicine to deliver care to patients could greatly improve access and quality of care, while maintaining patient safety.6 During its Annual Meeting in 2014, the AMA voted to approve a list of guiding principles for ensuring the appropriate coverage of and payment for telemedicine services. The AMA believes:

• Telemedicine applications provided over robust broadband networks can facilitate immediate diagnoses and care needed to prevent lasting damage to stroke victims, prevent premature births and deliver psychiatric treatment for patients in underserved rural areas.

• Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient).

Patients Gain More Convenient Access to Care

For patients, getting remote access to health care providers offers major advantages over traditional methods of delivery. At the top of this list is making certain types of care more accessible for those who struggle to get to distant medical facilities or hospitals. For example, videoconferencing can be used to connect patients with medical staff over the Internet.

Another benefit of telehealth is that it promotes patient centered health care such as:

• Patient-provider communications• Patient self management and provider feedback• Health literacy• Medication management• Provider-provider consultations• Changes in health and lifestyle behavior7

While not a substitute for in-person visits, telehealth can still provide face-to-face care and improve a patient’s understanding of his or her own health.

Enhanced Value for Rural Communities

There’s a shortage of some medical specialties in rural America, making telehealth even more critical in giving patients access to the care they need. A primary care physician in a rural community, for example, could refer a patient to a specialist miles away and leverage telecommunications technologies to connect the patient with this doctor. Telehealth chronic disease self-management programs can also be effective for boosting care access to isolated areas.8 To take advantage of telehealth’s opportunities, however, requires robust broadband connectivity, which is lacking in some rural areas.

Providers and Patients Benefit from Telehealth

6 http://www.ama-assn.org/ama/pub/news/news/2014/2014-06-11-policy-coverage-reimbursement-for-telemedicine.page

7 http://www.healthit.gov/providers-professionals/frequently-asked-questions/486#id1558 http://online.liebertpub.com/doi/pdfplus/10.1089/tmj.2013.0057

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Electronic Health Records (EHR) Enable Better Outcomes and Lower Costs

EHRs are real-time, patient-centered records in a digital format that make information available instantly and securely to authorized users. They may contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images and laboratory results.

Compared to paper records, EHRs offer a long list of benefits including:

• A broader view of a patient’s care to help providers make better decisions

• Ability to conveniently and rapidly share data with other providers involved in a patient’s care such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics

• Improvement in the accuracy of diagnoses and health outcomes

• Automation and streamlining of a health care provider’s workflow, leading to practice efficiencies and cost savings

The Federal Communications Commission (FCC) estimates that Electronic Health Records and Remote Monitoring technology could alone create over $700 billion in net savings over 15-25 years.9 More importantly, these savings are paired with better outcomes for patients.

Fast and Reliable Broadband is Needed for EHRs

After adopting the use of EHRs, health care providers must devote more attention to their data networks than previously required. Proper functioning of an EHR system depends largely upon the network on which it resides. Health care providers using EHRs — perhaps in tandem with ePrescriptions, inter-site communication and online medical registries — are critically dependent on network and application performance. Any drop in bandwidth or increase in latency can make these applications unusable or inaccessible, potentially compromising patient care.

Physician offices and clinics in rural communities may not have affordable access to sufficient broadband infrastructure, making the adoption of EHR more challenging. This was part of the impetus for the FCC’s development of the Healthcare Connect Fund, the newest component of the Rural Health Care Program.

In addition to EHRs, other high-bandwidth files also depend on robust bandwidth including X-rays, MRIs and ultrasounds as do high-bandwidth applications such as high-resolution video and video conferencing used in telehealth.

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Increased Use of Electronic Health Records

9 http://www.broadband.gov/issues/healthcare.html

Wi-Fi is Driving Improvements in Health Care

Health care providers, particularly hospitals, have benefited greatly from the widespread adoption of Wi-Fi networks and related technologies. According to the Wi-Fi Alliance, a global nonprofit industry association, Wi-Fi is driving new improvements in the flexibility and efficiency of clinical services in health care environments, and the market for Wi-Fi health care services is expected to grow to $1.34 billion by 2016.10

There are many health care applications and devices now in use that rely on Wi-Fi, and new ones are being created to take advantage of the mobile connectivity. Examples include:

• Wireless EKGs, infusion pumps and blood pressure cuffs

• Oxygen monitoring devices

• Smart beds with advanced fall monitors

• Mission-critical information applications such as access to electronic health records and real-time access to X-rays and MRI scans.

• Medical telepresence delivered via Wi-Fi helps scale provision of high-quality health care to remote and underserved areas.

The mobility provided by these Wi-Fi technologies enables clinicians to maintain access to accurate and timely patient monitoring while keeping their focus on patient care instead of administrative tasks. In addition, Wi-Fi is well suited to meet the growing connectivity demands from patients and their families in waiting rooms and lobbies. A successful end-to-end wireless solution can improve patient care efficiencies and enable medical practitioners to transform the way they share critical patient information.

Envisioning the Connected Hospital

Wi-Fi technology has changed the health care landscape and led to the idea of the Connected Hospital, a fully integrated hospital where wireless technology allows caregivers and patients to move throughout the hospital while providing

accurate, real-time monitoring.11 In the Connected Hospital, wireless technologies like Wi-Fi will fuel patient safety, data accuracy and mobility. Nurses will be able to monitor multiple patients remotely from one main station, receiving alerts and observing data captured on patients’ health in real-time. Doctors will be able to make more informed decisions with accurate and up-to-date patient information, leading to better patient outcomes. Mobile medical devices will even travel with patients so they can be monitored from the comfort of their own home.

Remote Monitoring Technology and Other Wi-Fi Applications

10 http://www.wi-fi.org/discover-wi-fi/healthcare 11 http://www.wi-fi.org/beacon/chris-downey/mobility-via-wi-fi-transforming-healthcare-for-all

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Broadband connectivity is clearly essential to 21st century health care and is transforming how and where this care is delivered. By providing instant remote access over high-speed networks to medical specialists, health care records and training, broadband helps increase efficiency, decrease costs, make services more accessible and improve patient results.

Staying Ahead of Needs and Challenges

At the heart of every health care facility’s communication network is one primary concern: the health and safety of its patients. It’s critical that information be shared quickly, reliably and securely.

That said, there are additional needs and challenges to be considered when making plans for broadband services and broadband-related technologies in the highly demanding 24/7 health care environment. They include:

• Increased use of electronic health records

• Increased bandwidth needs and data storage requirements

• HIPAA privacy and security rules regarding patient information and medical data

• Growth in long-distance video services requiring high bandwidth and high reliability

• Future facility expansions that require network expansion

• Controlling costs while keeping up with evolving health care standards

• Implementing reliable wireless coverage throughout the facility

Special Considerations for Hospital Wi-Fi Networks

Hospitals are currently confronting ever-growing wireless bandwidth needs based on today’s many wireless applications and devices. In addition, the hospital environment includes a range ofconstituencies including doctors, nurses, lab technicians and other caregivers who need wireless Internet for everything from their smartphones and tablets to X-ray machines. The complexity of Wi-Fi planning increases when you consider that many wireless users are patients and hospital visitors.

To ensure effective continuity of a hospital Wi-Fi network, it’s important for network architects to plan for a high level of system redundancy, abide by current security regulations, conduct proper site surveys and assess the types of devices that will be used.12

Broadband Planning Considerations for Health Care Providers

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12 http://www.mhealthnews.com/news/hospitals-confront-ever-growing-wireless-bandwidth-needs

Discounts on Expenses Related to Broadband Connectivity

The Healthcare Connect Fund is the newest component of the Rural Health Care Program, which also includes the Telecommunications Program, the Internet Access Program and the Rural Health Care Pilot Program.

The Rural Health Care Program provides funding to eligible health care providers (HCPs) for telecommunications and broadband services necessary for the provision of health care. The goal of the program is to improve the quality of health care available to patients in rural communities by ensuring that eligible HCPs have access to telecommunications and broadband services.

Participants in the Healthcare Connect Fund, whether an individual HCP or a member of a consortium, can receive a 65 percent discount for eligible expenses related to broadband connectivity, including equipment. Through access to telemedicine and support of electronic health records, networks of HCPs can save costs and expand access to health care. The Healthcare Connect Fund capitalizes on the benefits of these networks by encouraging the formation of state and regional health care consortia while continuing to allow for individual HCP applicants.

By providing this support to HCPs, the Healthcare Connect Fund will benefit consumers in rural areas. For example, they may be able to gain access to medical specialists at larger HCPs through telemedicine and experience better coordination of patient care via electronic health records.

Move Confidently with a Technology Partner

To navigate the changing landscape of communications solutions, you need a technology partner that’s up to the challenge. Look for a telecommunications provider with these attributes:

• Understands health care and has experience working with hospitals and clinics to help them select the most appropriate communications solutions to meet specific needs.

• Will help your health care facility understand and make full use of the Rural Health Care Program and its Healthcare Connect Fund to help pay for qualifying services and equipment.

• Offers a full portfolio of communications solutions to meet all of your data, voice and video requirements.

• Backs up its products and services with expertise in installation and maintenance, and will continue to be there to provide assistance for years to come.

Assistance Available from the Healthcare Connect Fund

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