Carr Backs 'More Permanent' Regulatory Relief for Telehealth

Congress and the FCC “need to make permanent a lot of the regulatory relief” and waivers that “enabled a real spike in telehealth usage,” said Commissioner Brendan Carr during a virtual symposium Thursday recognizing broadband access, adoption and use as a social determinant of health. The FCC has “got to make sure that we get affordable internet connections to every community,” Carr said.

“When we can keep people with their family … and still get high quality care to them, it’s a real game changer,” Carr said. Patients are less likely to have to miss a healthcare appointment in part because of access to telehealth, he said, applauding the FCC’s connected care pilot program.

“It was clear that telehealth would play a mission critical role in addressing COVID-19 early in the pandemic,” said Commissioner Geoffrey Starks, noting one-third of Americans used telehealth services during the pandemic's first six months. Telehealth has increased access to specialists and mitigated challenges “like travel and health conditions that keep people from seeing doctors,” and it reduces costs, Starks said.

The FCC Connect2Health Task Force studied whether there was a relationship between the level of connectivity and health outcomes at the community and population level, said Karen Onyeije, task force chief of staff. There “appears to be a connectivity continuum from access to adoption to utilization,” Onyeije said, and health is “a compelling use case for driving broadband access and internet adoption.”

There are three types of relationships between broadband connectivity and health, said Arielle Mancuso, task force director-research and data analytics. The first is that connectivity is a “tool ... leveraged in the implementation of a broadband-enabled health solution,” Mancuso said, citing glucose monitors that connect to a smartphone application. The second is that broadband is a social determinant of health, she said, “exerting an independent influence on health.” The third is that broadband connectivity is “critical to almost all activities of our daily lives,” Mancuso said.

Healthcare "can be a motivator for getting online," said Benton Institute for Broadband & Society Senior Fellow John Horrigan. Digital navigators can further help close the broadband adoption gap, Horrigan said. Municipalities "can be effective in this arena" and “we absolutely need to present these conversations,” said Joshua Edmonds, Detroit director-digital inclusion.

Access in rural communities is also a "really significant issue," said Intermountain Healthcare Chief Community Health Officer Mikelle Moore, saying policy level interventions “have the greatest ability to help the most people.” Healthcare systems should be involved in the state planning process for the new federal broadband funding, Horrigan said.

There’s still “some concern around equitable access to health services, especially for those with no technology literacy and people with disabilities in general,” said Madjid Karimi, health scientist-Department of Health and Human Service Office of Assistant Secretary for Planning and Evaluation. Video telehealth appointments require more complex setup and video-enabled devices in addition to broadband access, Karimi said, “which may present barriers for older adults, lower income households, and those with limited English proficiency.” Digital redlining “demonstrates that a lot of these inequities are systemic,” said Natalie Benda, Weill Cornell Medical College instructor-population health sciences.

“It’s really important that we use our experiences and our data to transform public policies,” said Karen Rheuban, medical director for pediatrics, University of Virginia Health System Office of Telemedicine. Telehealth “should be a major role in the care redesign,” Rheuban said. There’s “a lot of work left to be done to flesh out this theory of change,” said Susan Dentzer, America’s Physician Groups incoming CEO. That includes setting technical standards and code sets needed to ensure information is accurately captured on “what broadband as a social determinant of health means,” said American Health Information Management Association Vice President-Policy and Government Affairs Lauren Riplinger.

Broadband access “serves as a gateway for information” and services, Benda said, and affects health outcomes. Despite “moderate differences” in general telehealth use across demographics, there were “greater disparities among subgroups” for video services compared with audio-only, said Centers for Disease Control and Prevention Public Health Informatics Fellow Euny Lee. Video telehealth use is lower for Latino, Asian American and Black households than for white households, Lee said.

The lack of affordable broadband affects the ability to deploy certain emerging health technologies like remote patient monitoring tools and artificial intelligence, said David Rhew, Microsoft chief global medical officer. Improving digital and healthcare literacy will allow communities to “start taking advantage of those amazing technologies,” Rhew said.

Broadband is a “central component in order for folks to be able to achieve optimal health,” said Michael Crawford, Howard University College of Medicine associate dean-strategy, outreach and innovation. Some patients throughout the pandemic had no access to broadband, Crawford said, and if they did, the connection was “insufficient to be able to engage in a robust telehealth encounter.” A "new national broadband plan” is needed considering “the expanding needs and widening digital health disparities,” said Jill Egeth, Mitre managing director-healthcare delivery and new opportunities.

Some barriers “aren’t just about getting the device in the hands of the patient” or connecting them to the internet, said Elisabeth Myers, HHS Office of the National Coordinator for Health Information Technology deputy director-policy. “We need to figure out how to connect all of these data sources,” Myers said. It’s likely there will be more technologies where “the consumer doesn’t have to configure it” to use it and artificial intelligence can manage the data, said AT&T Vice President-Business Healthcare Joe Drygas. The question becomes how to get these resources to “those that are under-resourced,” Drygas said.