Let's take a minute to look at broadband!

In  January , the Federal Communications Commission released the  2016 Broadband Progress Report, focusing on their 2015 revised standard of 25 Mbps download/3 Mbps upload speeds for fixed services. Key findings included that 39% of rural Americans lack access to these speeds, compared to 4% of urban counterparts. However, the adoption rates (when these speeds are available) among rural and urban residents are nearly equivalent, at 28% and 30% respectively. The report also found that only 41% of schools have connections that meet the FCC's current goal of 100 Mbps per 1,000 students/staff.

According to the Report, Vermont has the highest percentage of rural residents without access to 25 Mbps/3 Mbps speeds in the northeast, although Maine has the lowest adoption rate. Here's a look at the entire region:

% of Urban Pop. Without Access
(25 Mbps/3 Mbps)
% of Rural Pop. Without Access
(25 Mbps/3 Mbps)
Overall Adoption Rate when 25 Mbps/3 Mbps is Available
CT 1% 1% 43%
ME 4% 17% 13%
MA 2% 10% 68%
NH 3% 15% 56%
NJ 2% 21% 58%
NY 0% 17% 39%
RI 2% 2% Data Withheld
VT 2% 27% 51%

NETRC continues to receive many questions about connecting to the patient's home and we are excited as opportunities continue to grow through improved technology, 
reimbursement, regulation, fixed  broadband availability (although speeds of 25 Mbps/3 Mbps may not be needed for a quality connection), and more. We also receive many questions about using mobile services, and although the FCC's Report does discuss mobile services to some extent, they have not yet set a benchmark speed.

Below are a few resources we have found helpful:
As always, please do not hesitate to reach out with questions about broadband or anything else telehealth/telemedicine.


The NETRC Team

Featured Webinar

Presented by the California Telehealth Resource Center

Presenter:  Daniel Kurywchak, Chief Technology Officer for the California Telehealth Network

Thursday, March 17, 2016, 2:00 - 3:00 pm EDT

This webinar will demystify how the Internet, wireless, cell phones, the cloud, broadband speeds, etc. work, which can greatly affect the outcome of your telemedicine consultation. If you have ever experienced video call drops, blurry or pixelated images, slow connections, lip sync problems, audio dropouts and want to learn what causes these issues and how to avoid them, this webinar is for you. 

Learn the harsh truth of how these subjects work and tricks of the trade to leverage them in your favor. Learn what a VPN does and if it helps guarantee your speed over the Internet and when to choose wireless vs. wired. We'll also discuss if cellular broadband is a better option than the Internet? How does a speedtest work and is it an accurate measurement of your connectivity? Does one video conferencing software package differ from others? We'll also discuss alternate options to greatly improve your telemedicine connection quality, as well as improving the overall success rate of each and every telemedicine consultation.

Federal Funding Reminder

The Federal Office of Rural Health Policy is accepting applications  (due April 8 ) for the Telehealth Network Grant Program to demonstrate how telehealth networks are used to: (a) expand access to, coordinate, and improve the quality of health care services; (b) improve and expand the training of health care providers; and/or (c) expand and improve the quality of health information available to health care providers, patients and their families for decision-making. The focus of this year's application encourages telehealth service delivery through School-Based Health Centers (SBHC), particularly those serving high-poverty rural populations. Approximately $6,000,000 is expected to be available annually to fund up to twenty (20) recipients.

Click here to watch the Telehealth Resource Center's webinar on School-based Telemedicine!

Content compiled by Michael Edwards, NETRC Consultant
Telehealth Policy News

This policy update provides details on telehealth parity laws mandating private insurance reimbursement that went in effect in New York and Connecticut on January first, profiles two telehealth bills under review by the New Jersey state legislature, and highlights findings by the Florida Board of Medicine the prohibit prescribing controlled substances by telemedicine.
Managed Healthcare Executive, February 11, 2016
The author foresees how several current forces will accelerate telemedicine adoption in 2016. These include the embracing of telehealth coverage by private health plans, the continuing advance of state legal mandates for reimbursement, the growth of international service programs, trends in employer offerings of telehealth in the workplace, and the progressive move by Accountable Care Organizations to opt for telehealth solutions.
mHealth Intelligence, February 04, 2016
The Senate bill S.2484 would expand Medicare coverage for remote patient monitoring under alternative payment models and for reimbursement of telehealth for stroke evaluation, care at Native American health centers, and at dialysis centers. IT is has been receiving widespread support among health care associations, patient advocacy groups, and the American Telemedicine Association.
MobiHealth News, January 28, 2016
The Centers for Medicare and Medicaid Services recently released a rule that requires initial face-to-face visits prior to initiation of home health services for Medicaid, with a provision that allows use of telehealth interactive video sessions to serve for such sessions if consistent with individual state regulations.

News on the Practice of Telemedicine

Buffalo Business First, March 4, 2016
Genesee Urgent Care has launched a telemedicine program that allows  Genesee Community College  students to receive services either remotely using videoconferencing technology from the college health office, or by coming to the urgent care facility.

ABC News, February 29, 2016
The organization Maine Family Planning plans to implement telemedicine facilitation of so-called medical abortion within early stages of pregnancy. Similar to model programs in Iowa and Minnesota, women accessing care at one of 16 regional family planning clinics will be able to consult with a physician by interactive video sessions, and if appropriate receive a prescription of medicine to terminate the pregnancy.

TechHealth Perspectives, February 26, 2016
This article reviews some available numbers for relative volume of telehealth reimbursements by Medicare and private insurance providers. Total nationwide payouts by Medicare for telehealth in 2014 was estimated at a paltry $14 million, and a recent review of a private claims database identified only 6,506 telehealth billings paid out of 96 million total claims in the database from 2009-2013.
Chicago Tribune, February 24, 2016
A profile is made of Thrid Eye Health's system for mobile telehealth linkage of nurses in nursing homes with primary care providers to guide care remotely and prevent progression of medical conditions to an ED visit. The system, will be deployed for a 44-facility chain in Texas and is being considered for adaptation for linkage to ED doctors for remote stroke assessments.
Health Affairs Blog, February 12, 2016
Trends in telehealth adoption by employee health plans are discussed, and some of the highlights from a recent guide to the role of telehealth in a "high-value purchasing strategy" are presented.

Rural Health Information Hub, February 8, 2016
In 2012, the Massachusetts DPH received funds from the Department of Justice  Office for Victims of Crime (OVC)  to support the  National TeleNursing Center (NTC) , the first national 24/7 sexual assault telemedicine resource for clinicians. Through a video conferencing system, NTC links Sexual Assault Nurse Examiners to clinicians in rural and underserved areas in order to provide help in the examination process of a sexual assault victim following an assault.
Fierce Health IT, January 27, 2016
In this special report, a dean from a medical school and a vice president from the Anthem health insurance giant discuss their efforts to advance patient health care access via telemedicine. The former highlights efforts at developing a clinical provider training and certification program, while the latter discusses facilitators and challenges to growth in its LiveHealth Online services as delivered through systems managed by American Well.
mHealth Intelligence, January 22, 2016
Last year, the Centers for Medicare & Medicaid Services instituted a reimbursement code for "Chronic Care Management", which covers indirect patient care efforts that can include elements of telehealth remote patient monitoring. However, the New Jersey physician interviewed here noted that the 20 minutes reimbursed per month is not enough to make the service feasible for his practice, so he has outsourced the phone-based check-in and data collection to a call center.
State Line, January 21, 2016
This highlights how Texas provides health care for state correctional inmates through telemedicine, treating 127,000 patients year at 83 facilities with substantial cost savings and safety benefits. Other programs in Wyoming, Louisiana, Colorado, and Washington are also described.

Telemedicine Technology News

Wainhouse Research Blog, February 8, 2016
Logitech recently released a new PC-based videconferencing product suitable for small conferences and meetings. The Logitech GROUP combines a USB-connected HD camera on a stand with pan-tilt-zoom controls and with a high-quality table-top speakerphone (MSRP $999).
MobiHealth News, February 09, 2016
In the year following the IBM launch of a health focused unit called Watson Health, numerous partnerships have been forged that aim to take advantage of its supercomputer and cloud-based access. Among initiatives highlighted here were promising plans to develop decision support applications for patient diagnosis and care with Boston Children's Hospital, Memorial Sloan-Kettering Cancer Center, and the Mayo Clinic.

Health Information Technology News

Fierce Health IT, February 23, 2016
The Office of the National Coordinator for Health IT recently announced that its ONC Tech Lab to review potential standards for health information technology, develop IT testing tools, promote pilot deployments of promising solutions, and promote innovation of new standards.
MobiHealth News, February 12, 2016
The HHS Office for Civil Rights recently posted updated guidance on its mHealth Developer Portal that provides developers with different scenarios in which HIPAA might apply to the data their app collects. The scenarios are useful for users of mHealth apps on which situations require actions to assure HIPAA compliance
Recent Telehealth Resources

Advanced Telehealth Solutions, Inc.  The essential guide to the home health value-based purchasing program, 2016 Link

Agency for Healthcare Research and Quality. Telehealth: An evidence map for decision making-draft report.  AHRQ, U.S. Dept. of Health and Human Services, 2016 pdf

Baron J, Hirani S, Newman S.  A mobile telehealth intervention for adults with insulin-requiring diabetes: early results of a mixed-methods randomized controlled trial.  JMIR Res. Protoc. 4(1):e27, 2015 Link

Bradbury A, Patrick-Miller L, Harris D, et al.  Utilizing remote real-time videoconferencing to expand access to cancer genetic services in community practices: a multicenter feasibility study. J. Med. Internet Res. 18(2):e23, 2016 Link

Canadian Agency for Drugs and Technologies in Health.  Telehealth for patients with heart failure: a review of the clinical effectiveness, cost-effectiveness and guidelines.  CADTH Rapid Response Reports, Dec. 2015 Link

Canadian Agency for Drugs and Technologies in Health.  Telehealth for patients with hypertension, coronary artery disease or implantable cardiac devices: a review of the clinical effectiveness, cost-effectiveness and guidelines.  CADTH Rapid Response Reports, Jan. 2016 Link

Catalyst for Payment Reform.  A guide for purchasers: How telehealth fits into a high-value purchasing strategy, January 2016 Link

de la Torre-Díez I, López-Coronado M, Vaca C, Aguado JS, de Castro C.  Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.  Telemed. eHealth 21(2): 81-85, 2015 Link

DeBlois D, Millefoglie M.  Telehealth: Enhancing collaboration, improving care coordination.  Nursing Management 46(6):10-12, 2015 Link

Federal Communications Commission.  2016 Broadband Progress Report.  FCC report to Congress, Jan. 2016 pdf

Health Care Cost Institute. An examination of private payer reimbursements to primary care providers for healthcare services using telehealth, United States 2009-2013.  National Academy for State Health Policy, 2016 Link

Knight P, Bonney A, Teuss G, Guppy M, Lafferre D, Mullan J, Barnett S.  Positive clinical outcomes are synergistic with positive educational outcomes when using telehealth consulting in general practice: a mixed-methods study.  J. Med. Internet Res. 18(2):e31, 2016 Link

Langkamp DL, McManus MD, Blakemore SD.  Telemedicine for children with developmental disabilities: a more effective clinical process than office-based care.  Telemed. eHealth 21(2): 110-114, 2015 Link

Lewiecki EM, Bouchonville MF 2nd, Chafey DH, Bankhurst A, Arora S.  Bone Health ECHO: telementoring to improve osteoporosis care.  Womens Health [epub ahead of print], Dec. 2015  Link

Owsley C, McGwin G Jr, Lee DJ, et al.  Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine.  JAMA Ophthalmol. 133(2): 174-181, 2015 Link

Roser P, Kalscheuer H, Groener JB, et al.  Diabetic retinopathy screening ratio is improved when using a digital, nonmydriatic fundus camera onsite in a diabetes outpatient clinic.  J. Diabetes Res. 2016: #4101890, 2016 Link

Ryan ME, Rajalakshmi R, Prathiba V, et al.  Comparison among methods of retinopathy assessment (camra) study: smartphone, nonmydriatic, and mydriatic photography.  Ophthalmology122(10):2038-2043, 2015 Link

Singh K, Drouin K,  Newmark LP, et al., Developing a framework for evaluating the patient engagement, quality, and safety of mobile health applications.  The Commonwealth Fund Issue Brief, February 2016 htm

Steventon A, Ariti C, Fisher E, Bardsley M.  Effect of telehealth on hospital utilisation and mortality in routine clinical practice: a matched control cohort study in an early adopter site. BMJ Open 6(2):e009221, 2016  Link

Zhang MW, Yeo LL, Ho RC.  Harnessing smartphone technologies for stroke care, rehabilitation and beyond.  BMJ Innovations 1:145-150, 2015 Link