The Explosion of Telehealth has IT Infrastructure Playing Catch Up
By Theresa Dudley
Telehealth has been around for decades, but only recently has it started to become mainstream. As the COVID-19 pandemic led to stay-at-home orders across the country and a need to lessen exposure and strain on the health care system at-large, health care organizations (HCOs) and provider offices closed for routine and non-emergency visits. This caused the use of telehealth to skyrocket.
For example, the telehealth provider Teladoc reported more than 1.6 million telehealth visits for the first quarter of 2020, up from about 780,000 at the end of Q1 2019.1 One industry report indicates there will be more than 1 billion virtual health care visits by year end.2 Another projects that the compound annual growth rate of telehealth will rise to
38 percent over the next five years in the U.S.3
As the barriers to telehealth adoption are removed — such as more acceptance of the technology by both patients and providers and improved reimbursement rates for services — health care IT leaders need to make sure they have the network capacity and performance to meet the increased demand.
Telehealth application growth and IT leader confidence
The Health Resources Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health-related education, public health and health administration.” It can include clinical services (known as telemedicine) and non-clinical services such as trainings.
Telehealth emerged in the 1960s as a way to connect high-risk patients in rural or underserved areas with specialist providers located in urban areas. It has since been useful in improving the health of communities by addressing social determinants of health (SDoH), which can include a patient’s access to health care services and specialists. Telehealth can improve SDoH by removing physical distance and access as barriers to care delivery.
Recognizing the benefits that telehealth care brings to rural communities, the Federal Communications Commission (FCC) created several programs to help rural providers access telecommunications services and high-capacity broadband connectivity at discounted rates.
As the funding amounts and the number of programs have increased over the years, so have the ways that telehealth is being used. Besides connection with out-of-area specialists, providers are using telehealth to provide basic preventive and mental health care, advice, reminders, education, intervention and monitoring via electronic telecommunication technologies. Some common telehealth applications include:
- Virtual visits: Remote medical exams that can assess, treat or triage certain conditions
- Remote patient monitoring (RPM): Medical-grade monitoring of certain biometric indicators
- mHealth: Use of wireless apps, devices and wearables to deliver services to patients
- Personal emergency response system (PERS): Devices that initiate an emergency response when a user has experienced a medical emergency
Telehealth technology typically gets great reviews. Nearly 80 percent of patients say telemedicine is more convenient to schedule,4 and 83 percent of patients feel telehealth care is as good as or better than an in-person visit.5 Seventy-seven percent of physicians who have used telehealth say it contributes to more efficient use of their time.6 However, some health care leaders are still wary of supporting telehealth programs.
One of the top three reasons why providers say they are slow to adopt telehealth programs is a lack of confidence in the reliability of the technology.7 Nearly half of health care executives estimate their current telehealth solution fails 15 percent of the time.8 To keep up with the increased use of telehealth, health care providers must have a fast, reliable network and a robust IT infrastructure.
Build an IT infrastructure capable of supporting telehealth
The foundation of a successful telehealth program is a dedicated fiber connection. The amount and speed of data transfer and video quality all depend on the speed of the Internet connection.
The FCC recommends for telehealth services like video conferencing a high-definition video data speed of 10 Mbps for smaller medical practices and up to 100 Mbps or 1 Gbps for larger facilities.9 However, according to a 2020 recommendation from the South Central Telehealth Resource Center, it is best to focus on per telemedicine unit per call, rather than by facility size when determining capacity needs. The center recommends 2 Mbps upstream and 2 Mbps downstream per telemedicine unit per call for optimum quality.10 The importance of a provider-to-provider Internet connection that gives you continuous and symmetrical connectivity between your local area network (LAN) and the Internet can’t be overstated.
A secure and reliable wide area network (WAN) is essential for telehealth services that require seamless collaboration across locations. Providers should consider seeking out an Ethernet service that offers real-time, low latency, secure and cost-effective connectivity. Managed software-defined WAN (SD-WAN) solutions can also be an option to improve application performance and reduce WAN complexity and management.
A successful telehealth infrastructure also needs to be flexible and scalable enough to handle Internet of Things (IoT) integrations, wearables and increasing numbers of providers and patients using their personal devices to access telehealth systems. More than 90 percent of doctors, 79 percent of health care executives and 51 percent of nurses report bringing their own device (BYOD) for use in their jobs.11
More and more HCOs are using clouds to store data. Establishing private connections to public cloud providers can reduce security risk and ensure fast and consistent high performance to the cloud.
Voice and collaboration solutions are also part of the IT infrastructure to support telehealth. The ability for staff, providers, departments and patients to be able to communicate is essential to the delivery of high-quality care that leads to positive patient outcomes.
We learned in research we conducted with HIMSS that multiple competing priorities, lack of time and lack of expertise are barriers to innovation for health care IT decision makers.12 To address these challenges, HCOs should consider the value of a managed services provider that can take on the day-to-day administration of their network services.
The right connectivity provider can help
Our research found that hospitals and health systems are focused on innovation, but are not confident that they are maximizing their partnerships with connectivity vendors to achieve their goals.
The right communications and connectivity technology partner can help HCOs design and deploy an IT infrastructure that can meet the increased bandwidth demands of telehealth and optimize innovation. HCOs should be challenging their technology partners to have health care expertise and deeply understand the digital infrastructure needs of telehealth implementations.
Only with all the right pieces in place — staff with the skills and time to innovate; a strategic approach to innovation; a powerful connectivity infrastructure; a connectivity vendor with health care expertise; and the ability to offload day-to-day IT administration — will HCOs’ digital health innovation efforts be successful.
1 “Teladoc Health Reports First-Quarter 2020 Results,” Teladoc company press release, 29 April 2020.
2 “Predictions 2020: Invest in Virtual Care to Meet Soaring Patient and Member Demand in 2020,” Forrester Research, April 2, 2020.
3 “Telehealth—A Technology-Based Weapon in the War Against the Coronavirus,” Frost & Sullivan, April 2020.
4 Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA; Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD, “Patient and Clinician Experiences With Telehealth for Patient Follow-up Care,” The American Journal of Managed Care, Jan. 14, 2019.
5 Ibid.
6 “Telehealth Index: 2019 Physician Survey,” American Well, 2019.
7 6 Essential Components of Building a Successful Telehealth Infrastructure, Advantech, 2019.
8 Ibid.
9 “What is the recommended bandwidth for different types of health care providers?” HealthIT.gov, 10 September 2019.
10 “Telehealth Assistance for Providers,” South Central Telehealth Resource Center, accessed May 22, 2020.
11 6 Essential Components of Building a Successful Telehealth Infrastructure, Advantech, 2019.
12 “Overcoming challenges to digital health innovation.” Spectrum Enterprise, 2020.
Theresa Dudley,
Program Manager Healthcare,
Spectrum Enterprise
Theresa Dudley is a health care technology expert with more than 20 years of program and product management experience. She frequently speaks at health care conferences and events about IT technology and innovation in health care. Theresa worked previously at leading high-tech companies including Cisco Systems, Nortel Networks and ADC Telecommunications (now TE Connectivity). Spectrum Enterprise, a part of Charter Communications, Inc., is a national provider of scalable, fiber technology solutions serving many of America’s largest businesses and communications service providers. The broad Spectrum Enterprise portfolio includes networking and managed services solutions: Internet access, Ethernet access and networks, Voice and TV solutions. For more information, visit enterprise.spectrum.com.
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