The digital divide—that long-recognized sphere of connectedness separating the digital many from the analog few—has profound implications for blocking telehealth programs.
It's a problem that the Department of Veterans Affairs has found a model for getting around and is preparing to expand: Giving out tablets.
Since April 2016, the VA has loaned more than 6,000 connected iPads to veterans who had a need for a teleheath solution but didn't have or couldn't afford a computer at home. The iPads allow veterans to communicate with their doctors from home using a video calling app, as well as enabling them to easily track and send relevant health metrics.
Neil Evans, M.D., chief officer for the Office of Connected Care at the Veterans Health Administration, said the program is expected to double the number of tablets loaned out next year.
"We need to make sure that we're delivering care, that we're delivering the same opportunity, to those who don't have the resources or opportunity or facility with technology," Evans said.
The VA isn't new to telemedicine, but what is new is the ability for veterans to access care in their own homes—without having to visit an interim brick-and-mortar facility.
Early telehealth applications were mostly used so remote patients could get access to a doctor or specialist who was far away. In these applications, patients would drive to a facility that employed just a few nurses and clinical staff. The staff would check the patient in and take their vitals, after which they would set up a secure video connection between the patient and the doctor they needed to see.
This model is still operable, but a point of emphasis for the VA—and telehealth programs in general—has been moving that point of contact closer to patients' own homes. As long as a patient has a connected device and a secure video chat app (both of which the VA provides), they should, in the majority of cases, be able to contact their doctor without leaving home.
Of course, this is a program for veterans, so there's a limit to how far it can expand. But as Evans explained, other telehealth programs are already looking to the VA as "an example of what is possible."
Take the FCC's connected care initiative, for instance, which earlier this year set up a $100M pilot project to connect patients-in-need. While the FCC's legal authority to help likely ends at setting up connections, rather than issuing devices, Commissioner Brendan Carr highlighted the VA's program as a model for device distribution.
For the VA, "it's a relatively short putt to get the devices—tablets, the glucometers—it's relatively easy for them to get the doctors and essentially pay for the care through the VA system. But where they have a challenge is a challenge that matches up with where we are. They have a challenge funding the actual wireless connections to the devices, so that's one example of where this program might fit hand in glove with some existing efforts that the VA's doing, and we can each contribute."
Currently, the VA just pays a wireless carrier, be it Verizon, AT&T or another, to connect each device. But that doesn't help in rural areas that have bad connectivity. So the FCC's ongoing efforts to build out rural broadband could play a critical role in further tablet loaning.