Broadband and Health: Bound by TeleMedicine

On August 14 I had the opportunity to sit in a small room with a handful of local journalists and staff at Seattle Children’s Hospital, also present, was the chairman of the FCC, Julius Genachowski.

We were gathered to see a demonstration of the hospital’s telemedicine network that serves a number of hospitals and rural clinics throughout the US Pacific Northwest, Montana and Alaska. These institutions do not often have the pediatric specialists needed in their localities.

At an increasing rate throughout the United States, smaller communities are finding that they do not have the expert resources required to diagnose and treat patients, especially children. Pediatric specialities are most often concentrated in large urban areas, grouped into major clinics or associated with large hospitals. The ability to attract from a larger pool of patients, close consultation with colleagues and the shared cost of expensive diagnostic equipment are the most common reasons for this trend.

Many small hospitals and clinics that are situated in less populated regions of the US, do not have the frequent occurrence of patient cases that justify the purchase of costly medical equipment or the ability to retain specialized pediatric talent. Despite these shortcomings, the ongoing need is still very real for the families in these regions.

The families of new borns and of very sick children are caught in between. They need to maintain their economic survival by keeping their jobs, keep other healthy children in school or they are burdened with the expense, in time and money, of long travel. On the other hand, a child is in need of specialized treatment and if that treatment must continue for more than a few visits, the family can be forced into some very hard choices.

Coupled with the problem of pediatric talent concentrating into urban areas where demand is greatest, there is also a growing shortage of pediatric subspecialists in the Untied States as a whole. According to the American Board of Pediatrics there are a suitable number of general pediatricians in the United States, about 70 per 100,000 children.

Certain pediatric specialties are becoming ever more scarce. There are only 751 practicing pediatric pulmonologists in the United States, 1 for every 100,000 children. In four states, Alaska, Idaho, Montana and Wyoming where over 940,000 children live, there are none. By comparison, Massachusetts, with the highest ratio of pediatric pulmonologists at 2.6 per 100,000 children, even there, it can take months to get an appointment for a child.

There are only 751 practicing pediatric pulmonologists in the United States, 1 for every 100,000 children.

TeleMedicine is an excellent example of a distributed resource network, the term can be applied in many systems but the meaning, in this context, is having a central location of experienced talent that can monitor and interpret remote sensing, while also offering diagnostic consultation. Sharing expertise across a wider geographic region not only offers increased quality of patient care, reduced family hardships but by having local doctors consult with more experienced specialists, this increases their diagnostic experience. Sharing information and expertise across a wider system avoids the potential of locking expertise into ‘knowledge islands’.

Seattle Children’s Hospital began their telemedicine system in 2001 with a $ 3.1 million Federal appropriation, administered by the Office for the Advancement of Telehealth within the Health Resources and Services Administration. This allowed the creation of an interactive video, teleconferencing and cardiology diagnostics service located at 11 sites throughout Children’s referral region in Washington, Alaska, Montana and Idaho. The Federal grant ended in 2005, well established, the telemedicine service was folded into Children’s general operations.

Children’s telemedicine system uses videoconferencing and a secure network to share medical records, echocardiograms and x-rays in real time. Specialists in Seattle can consult with doctors and families many hundreds of kilometers away and serve a region covering nearly 25% of the United States land area. The technological service is used by Cardiology, Endocrinology, Diabetic Services, Genetics, Neurodevelopment, Neurology, Nutrition Services, Psychiatry, Behavioral Medicine, Pulmonary Medicine and Rheumatology.

An alternative term for telemedicine was ‘care at a distance’ or absentia care and has been practiced for as long as medicine has existed. In its early form, the process was letter writing between doctors and then the telephone call, the former being less than real time and the later having no accompanying visual information or data, –now so critical to accurate diagnosis.

The backbone of any telemedicine system is high quality broadband, especially in rural regions. The cost of network equipment has continued to drop, as well as, the initial cost of equipment installation. The distribution, bandwidth and cost of ongoing broadband service has not followed as quickly. Telecoms have had little incentive to expand these systems, instead preferring to recapture further profit from existing, established infrastructure.

FCC Chairman Genachowski’s presence at the demonstration of Seattle Children’s Hospital’s exemplary telemedicine network will hopefully bring attention to the importance of broadband. As this critical infrastructure needs to be affordable, of high quality and pervasive to become a ‘raw good’ on which health and other industries may build their foundations.

If broadband continues to be marketed and priced as a ‘premium’ service then there is little hope that systems like Children’s telemedicine service will proliferate to other regions and cost pressures will certainly discourage the expansion of existing services. If the FCC and Chairman Genachowski, as well as, the United States Congress can provide the political leadership and the balance of protecting both telecom and the public’s interests, then there is a very good chance.

Originally published in the Swiss online newspaper, www.zitig.ch, reedited for WholeThinking.

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