From AFMC’s original blog post, “Broadband Access: A ‘Super’ Determinant of Health.”
Telehealth services have increased access to health care for many residents in rural Arkansas. However, the use of telehealth services requires a good Internet connection, which is still a problem in more rural areas across the state. In cities like DeWitt, the nearest hospital is 40 minutes away. If DeWitt residents don’t have a strong Internet connection to use telehealth services, they are playing a game of minutes, rushing to get critical care while others don’t have to leave their houses.
The Importance of Broadband
The Substance Abuse and Mental Health Services Administration (SAMHSA) calls digital access a super (or maybe not-so-super?) determinant of health due to its impact on other social determinants, such as education, health, and employment. Health care clinics and hospital systems must have robust, high-speed Internet connections in order to provide telehealth services.
The Federal Communications Commission (FCC) defines “high-speed Internet” as an Internet service with download speeds of at least 25 megabits per second and upload speeds of 3 megabits per second. Additionally, the majority of telehealth services must be fiber-driven in order to handle the speed and bandwidth needs for telehealth services.
According to Broadband Now, as of 2017, 78 million U.S. residents (24% of Americans) in rural areas lack access to coverage from fixed networks offering high-speed Internet. Another 14 million lack access to any broadband whatsoever.
Broadband Expansion Initiatives
Luckily, there have been several federal initiatives designed to make telehealth and broadband expansion a top priority. For Arkansas, the University of Arkansas for Medical Sciences (UAMS) formed the Institute for Digital Health & Innovation (IDHI) in 2019 to eliminate health disparities in Arkansas through digital health and health care innovations that improve access to and the quality of clinical care, education, and research.
IDHI joined with other Internet service provider (ISP) partners, including Middle Mile Fiber, to create the first and most robust optical network for Arkansas. IDHI has administered 162 grant awards and counting throughout the state, all designed to increase broadband access statewide.
Chris Charlton, Broadband Director for IDHI, said that, with more federal funding on the way thanks to the Broadband Equity, Access, and Deployment (BEAD) program, Arkansas will see 250-300 digital equity, literacy, telehealth, agricultural nursing, and broadband expansion programs across the state.
“Thanks to BEAD funding, UAMS IDHI contracted with Economic Development, a division of the Arkansas Department of Commerce, on a $555 million project dedicated to deploying ISP networks statewide,” he said. “We received our last round of funding in January 2023 before BEAD funding kicks in in early 2024.”
Around 210,000 households in Arkansas still do not have reliable broadband access. 110,000 of those households are the current focus areas for 40 active expansion projects. The rest of the households are those far off the grid. Because the installation costs per mile are so high, Charlton said that IDHI will rely on BEAD funding to provide a cushion. “By the end of 2026, we hope to reach 75% of the 210,000 households that remain without access,” he said.
Broadband Expansion Impact
To really understand the impact of Arkansas’ broadband expansion initiatives, Charlton said, you need to view the Broadband Coverage map. While it can be a bit overwhelming, this map breaks down broadband coverage for the entire state of Arkansas by census blocks. You can see how each county stacks up in broadband coverage.
As shown from the map, nearly every county in Arkansas, including Pulaski County (pictured), has areas of red, indicating gaps in broadband coverage.
“The red portions that you see on the map indicate gaps in broadband coverage,” Charlton said. “Green means that those areas are good to go. They have 100% broadband coverage. Each of the other colors represents funding projects currently in place, with light blue being broadband projects we’ve already built out with Economic Development and UAMS IDHI.”
From looking at the map, it’s clear that every county except Clay County in the far northeast corner of the state has at least one census block with no broadband coverage. “Some of the areas in west to northwest Arkansas are national forests. We’re not allowed to reach some of those areas due to rules and regulations regarding building on those lands,” Charlton said. “Even if you disregard the area with national forests, we still have a lot of work to be done. The 2024 project will help us reach health care constituents in those rural areas in red.”
Despite the progress to be made, Charlton has already begun to hear from state leaders about the impact the broadband expansion has had on rural Arkansas. “I’ve been out on road shows and had county judges and mayors from rural cities come up to me and tell me how their community wasn’t able to get broadband access until we started this expansion project. It’s just phenomenal to hear and see the impact we’re making throughout the state,” he said.
What can providers in these rural areas do in the meantime?
Until the broadband expansion projects begin in some of the more rural areas of the state, Charlton said it’s a waiting game. “The best thing to do right now is to reach out to your local mayor, county judge, or state legislator and let them know your area is underserved,” Charlton said. “Tell them you need access to be able to effectively care for patients in your area.” Getting legislators involved will allow for quicker delivery of broadband expansion in rural areas of the state once BEAD funding kicks in in 2024.
For health care clinics and hospital systems in the state who wish to provide telehealth services but need assistance in implementing a telehealth program, UAMS has implemented eLink. “eLink” helps in planning and implementation and manages the USAC Consortium, which offers connectivity for eligible sites at a discounted rate. Joe Schaffner, assistand director for UAMS IDHI and the South Central Telehealth Resource Center, said “eLink provides broadband access and equipment, such as telehealth carts, remote patient monitoring devices, and iPads, at a discount. Instead of paying tens of thousands of dollars outright for equipment, you can pay a monthly or annual fee.” UAMS also provides maintenance and technical assistance for involved parties. Learn more about eLink and the benefits it can provide.
What resources can patients in rural communities use to get access to telehealth services?
Even if broadband was available in these smaller communities, high installation and service costs often make it unaffordable for lower-income households. The American Health Information Management Association estimates that while 8 in 10 households with incomes of around $100,000 used wired high-speed Internet service at home, only 5 in 10 households with incomes below $25,000 did in 2021.
For residents who struggle to afford the high costs of Internet service and equipment, the FCC implemented the Affordable Connectivity Program (ACP), a benefit program that offers discounts of up to $30 per month toward Internet service for eligible households and up to $75 per month for households on qualifying tribal lands. Additionally, ACP provides discounts on laptops, tablets, and desktop computers.
UAMS eLink is leading the ACP efforts in Arkansas, providing assistance and support for families benefitting from these discounts. “Right now, we’re really focusing on outreach for ACP,” Schaffner said. “The funding has been provided by the FCC, but only about 30% of Arkansas households have tapped into this resource.”
Learn more about the eligibility requirements and see if ACP is right for your household.
Additional Telehealth Support
Telehealth Training. For those who need guidance, education, and resources for telehealth services, the South Central Telehealth Resource Center (SCTRC) offers services to Arkansas, Mississippi, and Tennessee residents.
SCTRC and UAMS IDHI have combined resources to provide guidance and support for health care providers who need education and training on telehealth and telemedicine. They provide self-guided learning, including podcasts, videos, and online resources, as well as instructor-led learning, including telehealth training kits, meetings and conferences, and webinars and virtual events.
UAMS HealthNow. UAMS HealthNow provides real-time access to a provider via video chat using your smartphone, tablet, or computer to patients within the state of Arkansas. For patients who have to travel long distances for routine checkups with their primary care provider, UAMS offers HealthNow, a virtual video appointment with a provider. HealthNow offers a variety of easy-to-use telehealth services, including virtual urgent care, telePrEP, a virtual hernia clinic, and COVID-19 services.
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