Leveraging Telehealth to Improve Health Care Access in Rural America: It Takes More Than Bandwidth
Authors: Bruce Baird Struminger, Sanjeev Arora
Journal: Annals of Internal Medicine (2019)

Editorials3 September 2019Leveraging Telehealth to Improve Health Care Access in Rural America: It Takes More Than BandwidthBruce Baird Struminger, MD, MA and Sanjeev Arora, MDBruce Baird Struminger, MD, MAProject ECHO, University of New Mexico, Albuquerque, New Mexico (B.B.S.) and Sanjeev Arora, MDProject ECHO, University of New Mexico, Abuquerque, New Mexico (S.A.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1200 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In their brief research report, Drake and colleagues (1) call needed attention to rural America's poor access to health care with their exploration of broadband Internet availability, which suggests potential constraints on uptake of video-based telemedicine. We commend the authors for highlighting this important issue but question the premise that inadequate broadband service is primarily responsible for low telemedicine use in rural communities. Although Internet speeds in many counties may not meet the Federal Communications Commission (FCC) standard of 25 megabits per second (Mbps), the U.S. Department of Agriculture supports broadband infrastructure for many rural health care providers, including Federally ...References1. Drake C, Zhang Y, Chaiyachati KH, et al. The limitations of poor broadband Internet access for telemedicine use in rural America: an observational study. Ann Intern Med. 2019;171:382-4. doi:10.7326/M19-0283 LinkGoogle Scholar2. U.S. Department of Agriculture. USDA Launches New Program to Create High-Speed Internet e-Connectivity in Rural America. Accessed at www.usda.gov/media/press-releases/2018/12/13/usda-launches-new-program-create-high-speed-internet-e-connectivity on 12 April 2019. Google Scholar3. Zoom Video Communications. System Requirements for PC, Mac, and Linux. Accessed at https://support.zoom.us/hc/en-us/articles/201362023-System-Requirements-for-PC-Mac-and-Linux on 12 April 2019. Google Scholar4. Project ECHO, University of New Mexico. Project ECHO: A Revolution in Medical Education and Care Delivery. Accessed at https://echo.unm.edu on 12 April 2019. Google Scholar5. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199-207. [PMID: 21631316] doi:10.1056/NEJMoa1009370 CrossrefMedlineGoogle Scholar6. Arora S, Kalishman S, Dion D, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood). 2011;30:1176-84. [PMID: 21596757] doi:10.1377/hlthaff.2011.0278 CrossrefMedlineGoogle Scholar7. Su GL, Glass L, Tapper EB, et al. Virtual consultations through the Veterans Administration SCAN-ECHO project improves survival for veterans with liver disease. Hepatology. 2018;68:2317-2324. [PMID: 29729194] doi:10.1002/hep.30074 CrossrefMedlineGoogle Scholar8. Scott Kruse C, Karem P, Shifflett K, et al. Evaluating barriers to adopting telemedicine worldwide: a systematic review. J Telemed Telecare. 2018;24:4-12. [PMID: 29320966] doi:10.1177/1357633X16674087 CrossrefMedlineGoogle Scholar9. Cason J, Brannon JA. Telehealth regulatory and legal considerations: frequently asked questions. Int J Telerehabil. 2011;3:15-8. [PMID: 25945185] doi:10.5195/ijt.2011.6077 CrossrefMedlineGoogle Scholar10. Alaska Community Health Aide Program. Web site. Accessed at www.akchap.org/html/home-page.html on 12 April 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: Project ECHO, University of New Mexico, Albuquerque, New Mexico (B.B.S.)Project ECHO, University of New Mexico, Abuquerque, New Mexico (S.A.)Acknowledgment: The authors thank Jennifer Snead, PhD, and Mary Darby for expert editorial assistance; Jared Shepherd for data support; and Drs. Michael Iademarco, Christopher Piromalli, John Scott, and Leonard Bikinesi for helpful reviews of the manuscript.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1200.Corresponding Author: Bruce Baird Struminger, MD, MA, Project ECHO, 1 University of New Mexico, MSC07 4225, Albuquerque, NM 87131; e-mail, [email protected]unm.edu.Current Author Addresses: Drs. Struminger and Arora: Project ECHO, 1 University of New Mexico, MSC07 4225, Albuquerque, NM 87131.This article was published at Annals.org on 21 May 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Limitations of Poor Broadband Internet Access for Telemedicine Use in Rural America: An Observational Study Coleman Drake , Yuehan Zhang , Krisda H. 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