Telehealth potential unrealized in places with poor internet; that becomes a bigger issue when telehealth is mandated

Homes in wealthy communities like the Blue Ridge Mountain Club near Boone, North Carolina, have access to high-speed internet. But most parts of the mountainous western region of the state, which has many poor people, have little broadband infrastructure. (Photo by Mark Darrough, Carolina Public Press, via The Daily Yonder)

The pandemic proved the great potential of telehealth for rural Americans, advancing its use years beyond what its advocates had expected. But it remains hamstrung by the lack of reliable, high-speed internet in many rural areas. That problem is explored in a four-part series by The Daily Yonder, the Institute for Nonprofit News, Carolina Public Press, Honolulu Civil Beat and Shasta Scout. with support from the National Institute for Health Care Management Foundation.

"Chronic health conditions and distance to medical services mean rural residents need more health-care specialists and better telehealth. But they are less likely than urban areas to get it," the Yonder says in introducing the first installment, in which Kristi Eaton cites examples from upstate New York, the Hawaiian island of Lanai, northern California and western North Carolina.

From the latter region, Eaton writes: "Lee Berger sat hunched over her laptop trying to complete a routine appointment with her primary-care doctor. But the 73-year-old, who has good hearing, couldn’t fully hear what the doctor was saying. It came down to unreliable internet access, she told Carolina Public Press. In North Carolina, an estimated 4 million residents don’t have access to reliable broadband service. This tends to have a greater effect on rural residents, many of whom live in communities that suffer most from a smaller supply of health professionals."

Fiber-optic service is provides the best broadband. but fewer than one in four households in western North Carolina even has access to fiber, Shelby Harris of CPP reports in the second installment, which reveals another problem: health-care providers who mandate telehealth, "such as Mission Health’s tele-hospitalist and tele-psychiatry programs. . . . Mission Health is the largest medical provider in the region" and is owned by HCA Healthcare, "the largest hospital system in the country."

Maggie Sauer, director of the North Carolina Office of Rural Health, told Eaton, “I’ve been in this business for a while, and I do not believe that without a hybrid telehealth model — in-person and then also telehealth — that we will be able to do what we need to do for our rural citizens.”