Residents in rural counties and other medically underserved areas are the most likely to face a double whammy: Not only do they have the lowest access to physicians and in-person health resources, but they also have the lowest access to the broadband internet services that can bring them telehealth, according to a new study published in Mayo Clinic Proceedings: Digital Health.
The study highlights problems faced by the estimated 7 million Texans in 2.8 million households without broadband internet access and the importance of new broadband infrastructure spending planned by both the U.S. government and Texas, says Austin psychiatrist Thomas Kim, MD, a member of the Texas Governor’s Broadband Development Council and consultant to TMA’s Committee on Health Information Technology.
The Mayo Clinic Proceedings study “is absolutely important” to help show where many high-speed internet deserts are in Texas, he said.
It compared the broadband internet access in 3,108 U.S. counties – including the 254 in Texas – to their rankings on three indices:
- The health care access barriers index,
- The resource-constrained health system index, and
- The social vulnerability index.
The comparison found that much of Texas was part of a geographic cluster in the southern U.S. with low broadband access and poor social and health indicators.
“Most health care-underserved communities in the United States are located in digital deserts with low high-speed internet access,” the study stated. “These digital barriers could prevent the successful expansion of digital health care services and might exacerbate health care disparities in these vulnerable communities.”
“We have an enormous opportunity in the state of Texas and federally … to significantly invest in [internet] infrastructure,” Dr. Kim said. “An inadequate infrastructure has for some time inhibited progress in health care and numerous other industries.”
The Biden administration recently announced a $42 billion initiative to provide that infrastructure by connecting all Americans to affordable, high-speed internet, which includes $3.3 billion for Texas – the highest amount of any state.
Meanwhile, Texas lawmakers approved House Bill 9 by Rep. Trent Ashby (R-Lufkin), which allocates $1.5 billion for the Texas Broadband Infrastructure Fund. Creating the fund also requires a constitutional amendment that must be approved by voters in November.
Barriers to adoption of telemedicine often go beyond geography, and the new federal and state investments need to address more than just infrastructure, Dr. Kim says. Challenges often include the cost of either a device or the cost of the connection itself, lack of relevance to the user, or a lack of digital literacy, according to a 2020 report by the development council.
“People without access to adequate broadband do not exclusively live in rural areas,” he said. “If we’re going to create an investment strategy, it should attempt to consider the nuanced needs of and benefits for as many Texans as possible, regardless of ZIP code. That said, building out our statewide network is a great place to start.”
The COVID-19 pandemic made telemedicine a viable option for most Americans, one strongly supported by the Texas Medical Association. The unwinding of the public health emergency makes telemedicine more difficult to provide in many ways, but it’s clear that both patients and physicians see it as a valuable tool.
Many people have gotten around the lack of broadband access by using smartphones to reach physicians for their visits, Dr. Kim says. While that was useful during the pandemic, it’s not a long-term solution for telemedicine because phones often do not provide adequate visual capabilities.
“If you were to go to a clinic … and speak to your doctor through the door after which he or she slides a prescription under the door, I don’t think you would be satisfied or consider it a proper visit,” he said. “While the phone remains an important tool, it is not the same as telemedicine. More and better broadband throughout the state spares us from having to settle for less than we deserve.”
For more information and helpful resources, check out TMA’s telemedicine webpage.