by Dr. Kay Sackett – Senior Editor
Sackett, K. (2013). Reflections on Broadband Connectivity and Healthcare in Rural America. Online Journal of Nursing Informatics (OJNI), 17 (1), Available at http://ojni.org/issues/?p=2383
Big business requires broadband to interact with consumers and suppliers. Healthcare is big business. The resultant provision of “E-healthcare services” requires broadband with bandwidth capable of moving huge amounts of data and graphics intensive content within and between consumers and providers in all types of healthcare organizations throughout the United States. Stated differently, “e-healthcare services” require access by consumers and providers via fiber optic cable rather than the traditional phone line copper wire used to “dial-up” the Internet. The significance of this disparity in access and service continues to be addressed by healthcare reform.
Healthcare reform continues to be a significant focus of President Obama’s tenure in the White House. The adoption of Electronic Health Records (EHR) slowly continues across the healthcare landscape of America. Monetary incentives for healthcare reform have been included, most recently, in the American Recovery and Reinvestment Act of 2009, the Health Information Technology for Economic and Clinical Health Act of 2009 and the Patient Protection and Affordable Care Act of 2010. The adoption of Health Information Technology (HIT) is expected to improve the quality, efficiency, access and safety of healthcare. Ultimately, the Health Information Exchanges (HIE) are expected to provide electronic flow of health information to both consumers and providers in addition to the aforementioned improvements to healthcare. A glimpse of current events that impact broadband connectivity and healthcare in frontier and rural America will be presented for your consideration in the succeeding paragraphs.
Broadband connectivity in rural America is the focus of a report by Kuttner (2012). Kuttner (2012) discusses the economic impact and opportunities of broadband for rural Americans. He reports that access to the Internet is unequal and a “broadband gap” exists between urban and rural America. Support for his statement is provided by a look at the National Broad Band Map, a collaborative project by the Federal Communications Commission (FCC) and the National Telecommunications and Information Administration (NTIA). The National Broadband Map (2012) can be accessed at http://www.broadbandmap.gov/download/Broadband%20Availability%20in%20Rural%20vs%20Urban%20Areas.pdf
While the accuracy of the broadband map has been debated, it is an attempt to quantify the number of people who do not have access to wired or wireless broadband in rural and urban America. The report suggests that 9.8 million consumers who live in rural America do not have service that meets the minimum FCC broadband download standards of 3Mpbs and 768kbps for upload speed while 84.7% of rural consumers meet or exceed the FCC standards. Pause a moment and compare the .8 million urbanites who do not have access to basic broadband services versus 99.7 % Internet saturation for urban dwellers that meets the minimum or greater FCC standards. It is evident there remains a disparity between rural and urban dwellers ability to access the Internet (National Broadband Map, 2012).
The disparity in Internet access impacts rural dwellers opportunity to participate in healthcare. The invention and adoption of new technologies that require access to the Internet continue to proliferate. Selected examples of Internet based technologies include tele-health initiatives for e-diagnosis, e-prescribing, e-imaging, e-mental health and psychiatry visits, e-support groups and other “e-healthcare services” including the ability of consumers to access their EHRs and dialogue with healthcare providers via web-based portals.
The need for improved broadband access in rural areas also effects continued adoption of EHRs by hospitals, clinics and physicians offices that is crucial to further healthcare reform. A collaborative report generated by the Robert Wood Johnson Foundation, MATHEMATICA Policy Research and the Harvard School of Public Health extrapolated information from two 2011 surveys; The National Ambulatory Medical Care Survey: Electronic Medical Records Supplement sent to office-based practicing physicians excluding pathologists, radiologists and anesthesiologists and the American Hospital Association Health Information Technology Supplemental Survey sent to hospital CEOs or their designee. http://www.healthreformgps.org/wp-content/uploads/74262.5822.hit_.full_.rpt_.final_.041612.pdf
Two items of interest from the collaborative report, among many, relate to broadband connectivity for rural Americans and their healthcare organizations. It is no surprise than urban healthcare organizations, physicians, and consumers are more wired, have access to faster broadband and are generally further along with EHR adoption, implementation of meaningful use standards, and incorporation of HIT and HIE initiatives than are rural areas. Identified gaps in EHR adoption are directly related to the size, location (rural versus urban), and teaching versus non-teaching status of hospitals. It appears continues to be, for the foreseeable future, a “broadband gap” between rural and urban dwellers.
In summary, the need for rapid transmission of health information is stymied by limited to no Internet access in rural America. Without basic, or better yet, exceptional broadband access via the Internet, rural consumers, healthcare providers, and healthcare organizations that provide services, remain at a distinct disadvantage when attempting to access “e healthcare services”.
Robert Wood Johnson Foundation. (2012). Health information technology in the United States: Driving toward delivery system change. Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2012/rwjf72706
Kuttner, H. (2012). Broadband for rural America: Economic impacts and economic opportunities. Retrieved from http://www.hudson.org/files/publications/RuralTelecom-Kuttner–1012.pdf
National Broadband Map. (2012). Broadband availability in urban v. rural America. Broadband Statistics Report. Washington: National Broadband Map. Retrieved from http://www.broadbandmap.gov/download/Broadband%20Availability%20in%20Rural%20vs%20Urban%20Areas.pdf