key: cord-0904790-u2dulkm0
authors: Julien, Howard M.; Eberly, Lauren A.; Adusumalli, Srinath
title: Telemedicine and the Forgotten America
date: 2020-07-28
journal: Circulation
DOI: 10.1161/circulationaha.120.048535
sha: a84c6f6f605aac8648cecb785af63cbf0cd5304b
doc_id: 904790
cord_uid: u2dulkm0

nan

Circulation. 2020;142:312-314. DOI: 10.1161/CIRCULATIONAHA.120.048535

July 28, 2020 service providers. Real-world testing in Pennsylvania revealed that median speeds for most of the state did not meet the federal definition for broadband defined by the Federal Communications Commission as download speeds of at least 25 Mbps and upload speeds of at least 3 Mbps. 3 Access by no means indicates subscription, of which a key component is affordability. On closer examination of broadband access, a stark landscape emerges. Urban centers are not immune to shortfalls in access. In 2018 New York City released Truth in Broadband: Access and Connectivity, which noted that 31% of households in New York City lack a home broadband subscription. The rates of absence of connectivity are higher for black and Hispanic residents (32% and 33%, respectively) than among white residents (21%) of the city. The city's poorest experience a similar fate with 56% lacking a broadband connection.

Our collective failure to treat widespread access to high-speed internet as the public utility that it has become sets the stage for reliance on expensive mobile data plans to fill the connectivity void. In 2018, the United States was the 5th most expensive mobile data market by median gigabyte price among European Union and Organization for Economic Co-operation and Development countries. 4, 5 On the unsteady foundation of the preexisting digital divide, a new tower of inequity in access to care will be built in the era of postpandemic recovery unless decisive action is taken. As a first step, the Centers for Medicare and Medicaid Services have ensured that patients and healthcare providers are not penalized for lack of broadband connectivity by ensuring, in many cases, telephone and video-based telemedical activities are viewed and reimbursed similarly. This will help to mitigate unintended barriers to accessing care resulting from unequal access to high-speed internet required for optimal video interactions; however, these changes are currently only temporary and must be made permanent.

As the United States transitions to a phased reopening, national guidelines released by the White House recommend that vulnerable individuals continue to shelter in place. The definition casts a wide net that includes millions of people "with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes [mellitus], obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy." Increasing availability of affordable access to high-speed internet and telemedicine devices will be crucial if we are to ensure that all Americans have access to the care they need in the next stage of this pandemic. As this field grows, additional research is needed to help outline best practices for telemedicine implementation with Figure. The telemedicine landscape: modalities, benefits, and barriers to implementation.

Unavailable to 21.3 Million Americans, BroadbandNow Study Indicates 42 Million Do Not Have Access

Broadband Availability and Access in Rural Pennsylvania. The Center for Rural Pennsylvania

Consumer affairs committee public hearing

The state of 4G pricing. Digital Fuel Monitor 10th release

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