Join us for this timely discussion with Lydia Kotowski as we break down key policy updates and what they mean for telehealth providers.

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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.

For more information on important health care topics, follow AFMC on Facebook, Instagram, LinkedIn, X, and YouTube.  

Subscribe to our newsletter for the latest news and updates, including the most recent episode of AFMC TV.

Source: https://www.afmc.org/blog/broadband-access

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Provider-to-Provider consults are a valuable component of patient care towards better health outcomes. This type of consult occurs without a face-to-face patient encounter, and is initiated by a physician or clinician seeking a specialist’s expert opinion. eConsults allow both the physician and the specialist to work at their own pace within a specific time period.

Our new Education Brief: eConsults will give you a high-level overview of eConsult concepts, and is designed especially for providers and clinicians.

This interactive module helps participants:

• Define eConsults
• Discuss the benefits for clinicians and patients
• Investigate potential eConsult workflows

Don’t miss this opportunity to learn more about eConsults!

Take This Course!

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Remote Patient Monitoring (RPM) programs collect biometric data from patients in one location and electronically transmit that information to healthcare providers in a different location for assessment and recommendations. It’s a common clinical practice for many clinicians, and can be a valuable tool to utilize when managing your patients’ chronic diseases.

Our new RPM module will give you a high-level review of RPM concepts, and is designed especially for providers and clinicians.

This interactive module helps participants:

• Define Remote Patient Monitoring (RPM)
• Identify patient populations and use cases for RPM
• Discuss RPM conceptual models
• Develop clinical workflows
• Identify RPM medicare CPT codes
• Explore RPM technologies

Don’t miss this opportunity to learn more about Remote Patient Monitoring!

Additional Resources:

Telehealth Roundup: Remote Patient Monitoring

Telehealth Roundup: RPM Billing Panel Discussion

Webinar: Remote Patient Monitoring – A Mississippi Story

Blog Post: Remote Patient Monitoring Helps Uncover Child’s Undiagnosed Condition

Blog Post: Remote Patient Monitoring (RPM): Enabling Patient Care Outside of the Clinic

National TRC Webinar: CCM and Remote Patient Monitoring Improve Care Coordination & Increasing Revenue

Take This Course!

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Lessons learned: “Don’t go live until you have the majority of the kinks worked out. Prepare to be flexible and roll with the punches because there are plenty of things you didn’t anticipate or think of.”

Successes: “Hearing how much the patients appreciated our service is what made it all worth it. Being able to completely flip our service to COVID screenings within 12 hours and be able to maintain a massive volume of calls was solely due to the amazing team work and dedication of the staff.”

Challenges: “Getting the word out about our service; especially to rural Arkansans. Marketing in a way that reaches a broad patient base. Helping non tech-savvy patients with the technology glitches they experience.”

Words of wisdom: “Hire a fantastic team. Have faith that it will work out–maybe not as you expected, but it will be ok. Ask for help when you need it. See the value of what your service offers and really believe in it.”

Have a Real World Example of your own?

Do you have a time in which telehealth has impacted your life? We’d love to hear your story! Please complete the form below to share your Real World Telehealth Example with the SCTRC team.

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Tuesday, July 16 at 3p Central

Presented by Dr. Kristi Henderson, DNP, Director of Telehealth at the University of Mississippi Medical Center (UMMC). Dr. Henderson’s talk is titled, “Telehealth Reimbursement: Mississippi’s Journey to Private and Public Insurance Reimbursement.” 

Henderson and other leaders at UMMC were instrumental in getting telehealth legislation passed earlier this Spring. Hear how Henderson was able to pass progressive legislation in the deep south. That’s no knock on Mississippi, believe me. The other two states in our south central region, Arkansas and Tennessee, have not been able to achieve legislation to this magnitude.

Click here to register for the free telehealth webinar from Dr. Henderson.

Thursday, July 18 at 1p Central

The National Telehealth Webinar Series presented by the National Network of Telehealth Resource Centers. This month presented by Barry W. Heath, MD from the University of Vermont. Dr. Heath’s talk is titled, “Pediatric Critical Care Telemedicine.”

Dr. Heath serves as the Chief of the Division of Inpatient and Critical Care Pediatrics, Fletcher Allen Health Care/University of VT College of Medicine. This webinar should be particularly interesting to those involved in rural emergency medicine and pediatrics.

Click here to join the free telehealth webinar from Dr. Heath.

Please help spread the word. Share this post on twitter, facebook or your site with the social links to the right. You can print the flyers from each webinar and post in your area at work.

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Dr. Wilbur “Chuck” Hitt, MD and Gordon Low, APN conducting a telemedicine clinic.

According to the NTPRC the series, “features exemplary telehealth programs throughout the United States, whose approach and application of telehealth represents a useful reference for providers, policymakers, insurers, and other stakeholders interested in telehealth.”

The thinking behind the program, according to Mario Gutierrez, the NTPRC executive director, is to highlight creative and successful applications of telehealth.

Gutierrez said, “From our perspective, it is critically important to demonstrate to policymakers, health care providers and payers, and consumers that technology  can make a real difference in improving both the quality and efficiency of health care, particularly for the underserved.”

Tina Benton, Program Director for the ANGELS program, said,”the program is insuring that all high risk obstetrical patients in Arkansas have access to maternal fetal medicine subspecialty care , telemedicine has been a great tool, which now we plan to expand our reach by using tablet and smart phone technology  for physician guideline access and home monitoring of patients.”

As the article states,

“there is much that can be learned from the ANGELS program about the best practices that exist in the field of telehealth.  They have successfully utilized telehealth to reduce the infant mortality in their state, making the program a model for other specialties and states.  Of the many best practices to be taken away from the program, their efficient use of technology, outreach activities and ongoing training and education are three to learn from and be inspired by.”

We look forward to seeing how the series progresses. As telehealth has exploded there are more and more excellent programs to feature.

While I’m at it I’ll put in a plug for the NTPRC’s nifty interactive policy map and its extensive list of pending legislation categorized by jurisdiction, type and topic. A very useful resource.

Roz Perkins, APN, and Curtis Lowery, MD, conducting a high risk OB clinic.

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AR SAVES (Stroke Assistance through Virtual Emergency Support) is reaching Arkansas patients daily.  With the use of technology ER physicians can now have their colleagues from neurology consult at a moment’s notice.  Through technology a patient can be seen by the consulting physician and a series of visual tests can be performed while reviewing radiology images simultaneously.  This technology is improving care and diagnosis in a time when the  healthcare landscape is in turmoil.  (Here’s an article on what we’re facing.) There are:

• Not enough physicians
• Too little EMS coverage
• An increase of people taxing the system due to baby boomers living longer (among other things).

All this is happening while payments for these services continue to erode.  Despite the system being in turmoil, Telemedicine is acting as a positive change agent.

The big question is can this work? The answer is YES.  It is working – not just in Arkansas but across the country as well. As technology continues to move into virtual medicine – so brings the issue of accessing these programs and making sure they are available.  It may not be that you do have telemedicine – the legal issue may be if you don’t!  The storm is approaching … do you have your telemedicine umbrella?

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