Better Medicine Requires Best Broadband


Telemedicine was a niche option at the beginning of 2020, viewed as a potent tool for delivering better health care to rural America and for the rest of us a quick doctor’s consult for minor ailments if you couldn’t get a same-day office appointment and didn’t want to pay for an expensive ER visit. 

Digital health care solutions enabled physicians to deliver faster and more effective outcomes to people distant from a big city hospital.  At the same time, the need for gigabit speeds and fiber networks to support health care became clear.

COVID-19 and social distancing moved tele out of the niche and into the mainstream. By the end of March, telemedicine video calls became the first option for doctors and patients alike, enabling health care workers to gather basic information, screen patients, and provide prescriptions when appropriate.

The psychiatry profession went all in on videoconferencing, with the Department of Health and Human Services (HHS) waiving penalties for using non-HIPAA solutions such as Skype and Facetime so therapists could continue to work with patients using available tools during the current crisis.

Telehealth refers broadly to the use of technology and services to provide care and services at a distance, while telemedicine is the formal practice of medicine using technology to deliver care at a distance, usually with a physician in one location using broadband services to deliver care to a patient at a distant site.

Today’s telemedicine boom is driven by virtual office visits between patient and doctor but there has been a steady business of conducting medical imaging tests remotely,  since an X-ray, CT, MRI, or ultrasound can be read just as easily by a specialist two hours away using a broadband connection from his home rather than in an office down the hall from the equipment.

Today’s and tomorrow’s digital health solutions need broadband and lots of it. Successful rural telemedicine practices cite requirements of 100 Mbps or faster speeds for the most effective use of time and equipment by doctors, specialists, and patients – anything less and time is wasted waiting on image transfers and cloud applications to load.

Gigabit fiber is preferred, with the speed necessary to support easily and quickly moving images between diagnostic equipment, cloud storage, specialists, and hospitals, permitting simultaneous access to high-quality imagery and electronic health records (EHRs).

Satellite Med, based in Cookeville Tennessee, initially used the area’s copper-based network for telemedicine but found the experience frustrating since too much time was wasted on waiting for diagnostic scans and EHR information to download. The arrival of fiber broke the bandwidth bottleneck, enabling doctors to make the best use of their time while patients could be seen sooner and diagnosed more quickly.

In addition, fiber provides better physical security, symmetrical bandwidth – especially important for the growth of multi-party video conferencing between doctors, patients, and specialists across multiple locations – along with a clear upgrade path to faster speeds by replacing electronics. Copper-based networks, including xDSL and cable plant, are reaching the end of their useful life and extremely limited or incapable of delivering symmetrical gigabit-class bandwidth services.

Prior to the second quarter of 2020, telemedicine was siloed and not integral to a typical doctor’s office practice. The medical community at large was slow to wholeheartedly embrace EHRs replacing paper files with a centralized system for more accurate patient records and faster billing.  Telehealth solutions had more success, enabling patients to schedule appointments, access billing and medical records, and engage with their doctors and their health care systemsmore conveniently and directly outside of office visits and phone calls.

After the crisis is resolved, doctors and health care systems will have to process the industry’s crash course in telemedicine and integrate it into daily practice. Like the arrival of email, websites, and Amazon delivery, once people get a taste of a useful service that saves time and promotes safety, they don’t want to turn the clock back.  In addition, the medical community will have to figure out best practices for broader telehealth initiatives for in-home/on-the-go monitoring, seamlessly incorporating data from IoT health tech devices such as blood pressure cuffs, pulse oxygen monitors, and electrocardiogram capabilities built into smart watches.

The MAGIC Healthy Smart Home project in Westminister, Maryland is one effort to bring together medical best practices with off-the-shelf consumer health and fitness tech and gigabit broadband.
“We are collaborating with local non-profits to put sensors in two group homes serving adults with disabilities,” said MAGIC President Dr. Robert Wack. “We’re trying to create technology to generate insights into their health status, keeping them out of the ER and hospital, helping them them lead healthier lives.”

Heathy Smart Home hopes to improve health outcomes and quality of life for adults with disabilities, storing fitness and health data in a secure and controlled manner rather than letting it being assimilated into separate third-party silos for resale without benefit to the individual. Information over weeks, and months will be collected and used to train proprietary clinical algorithms for the benefit of the individual.

Regardless of what you call the these technology today – telemedicine, telehealth – it will all just be “medicine” five years from now, with currently siloed and emerging applications fine-tuned for HIPPA compliance, optimized for ease of use for doctors, patients, and specialists, and integrated into the mainstream instead of viewed as nifty toys.  Normal usage and acceptance of digital health care doesn’t happen without the best broadband possible, requiring gigabit or faster speeds today and a fiber network architecture able to easily scale and cope with future applications. Legacy solutions such as xDSL and cable have already demonstrated strains in supporting large scale demands for symmetrical bandwidth, a deficit slowing adoption and efficiencies in providing care.

Gigabit-class broadband is also necessary for the latest wave of lower-cost, network-enabled imaging equipment, tapping into off-the-shelf tablet power. Today’s portable ultrasound equipment from Butterfly, Clarius, and Phillips leverages Apple IOS and Android to keep costs in line. Connecticut-based Hyperfine has rolled out a portable $50,000 MRI system for bedside use, designed to be wheeled between rooms, plugged into a standard wall outlet and uses an iPad to display imagery at point of care.  Portable CT scanners are being incorporated into ambulances to create specialized mobile stroke units, enabling immediate diagnosis and rapid treatment options.

Smaller, more affordable imaging equipment opens new opportunities for rural health and time critical care for trauma, heart attack, and stroke.  Diagnostic gear can become more distributed for more efficient and effective care to patients by health care systems.  In combination with specialists only a click away, time, money, and lives will all be saved by leveraging gigabit-class broadband to provide improved medical care to a broader population beyond big city hospitals and specialized clinics.

Access to the best medical care today and in the future will only be possible through gigabit speed fiber networks, increasing access to and options for doctors, patients, and health care systems to save time and lower the cost of delivering care while providing better outcomes for society and the individual. Communities, service providers, and health care organizations need to realize investing in fiber today is the best option today and for the future.

This article was first published inside the latest edition of Disruptive Telecoms, a initiative

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Gary Bolton is working as the VP Global Marketing at ADTRAN. With more than 25 years in the telecom industry, Gary Bolton joined ADTRAN in 2008 as vice president of global marketing. In this role, he is responsible for all aspects of marketing for the company worldwide as well as regulatory and government affairs. Bolton has been highly involved in Washington, influencing the FCC and congressional proceedings such as broadband stimulus, the National Broadband Plan and USF Reform. He is also very involved in ADTRAN’s local community, serving as the Board Chair of the Huntsville Madison County Chamber and as an adjunct professor in the College of Business at the University of Alabama. Prior to joining ADTRAN, Gary held executive management positions in a number of high tech start-ups as well as large publicly traded companies in marketing and product line management. He holds an M.B.A. from Duke University and a B.S. in electrical engineering from North Carolina State University.