“If the overall strategy is to make telehealth a part of 21st-century city and rural living, if it’s part of our vision that telehealth is the future of health care, we’re going to have to come up with lots of different ways to reach lots of different communities,” says Francella Ochillo. She is executive director of Next Century Cities, a nonprofit organization that supports mayors and community leaders across the country as they seek to ensure that everyone has access to fast, affordable, reliable internet.
One of those ways may be public libraries. In 2018, people made 1.2 billion visits to the more than 9,000 public libraries across the U.S., and 78 percent of those libraries offer online health resources.
In community broadband, libraries are considered “anchor institutions.” Like anchor tenants in a mall, libraries and other institutions, such as schools, hospitals and assisted living facilities, all contribute to the financial stability of broadband networks. Libraries drive large numbers of people onto networks. Now they can drive thousands to telehealth through those networks.
Setting Expectations
Libraries are realizing that they can be in the vanguard of transforming health care delivery in urban and rural areas. But telehealth providers must communicate what resources and tools they need libraries to offer. Furthermore, wherever communities and libraries want telehealth delivered, broadband infrastructure must be in place. No broadband, no telehealth.
“In most of the counties I’ve worked in across the country, county health departments survey people in the communities to find out what kinds of issues are out there,” says Peter Caplan, managing consultant for New York–based eHealth Systems and Solutions. “What are you trying to do? Are you trying to do initial assessments and screenings to identify the chronic conditions that eventually create expensive health problems?”
As a part of a health needs assessment, asking stakeholders and the general public what they want telehealth to do for their community is important. Caplan adds, “Do you have a lot of diabetes, do you have obesity? Do you have more than the national average of heart disease? A library could offer just basic screening, and gather data to determine how pervasive certain chronic conditions are.”
Dr. Robert Wack, a pediatrician and chief medical information officer at Frederick Regional Health System in Maryland, knows what’s needed to make telehealth work. He was president of the Westminster (Maryland) City Council when the city built a fiber-to-the-home network. “Libraries and health care partners must have realistic expectations of broadband and telehealth outcomes,” he advises. “If the partner doesn’t have employees dedicated to this effort, it doesn’t matter what the technology’s capabilities are.”
For the convenience of other patrons, libraries might want to schedule different types of telehealth for certain times of day. Parents with toddlers may want to schedule hours when there are typically few patrons, but mental health and psychiatric treatment may ideally be available anytime. “You’re adding a ‘waiting room’ environment to the library,” Dr. Wack says. “Broadband speed and reliability have to be exceptional.”
Libraries are expanding remote capabilities by offering more laptops and portable hot spots. Libraries should consider long-term laptop loan arrangements for patrons with chronic illnesses so they have few disruptions of their telehealth services. Broadband network owners may want to partner with libraries to ensure patrons have affordable broadband.
Telehealth technologies have great possibilities, but Dr. Wack cautions against overreliance. “There are variables that limit access to health care, such as the social determinants of health or ethnicity, none of which broadband can fix.”
More Than Video Chat
Telehealth often is defined too narrowly. It’s more than video chats; it uses intranets and internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record and/or report on the continuum of care people receive when ill, injured or wanting to stay well.
This definition can be taken one step further to differentiate between three concepts: real-time telehealth, store-and-forward telehealth and “passive” telehealth. These different versions require different broadband approaches.
Real-time telehealth refers to activities happening “right here and now” involving medical or health care professionals. For instance, in a library setting, a patron is on a video chat with a doctor from a study room or other enclosed, private space (kiosk). Another example is a traveling nurse setting up in a room to do medical screenings with patrons and video conferencing with a doctor in another location if patrons have questions.
Store-and-forward telehealth is collecting medical data and sending it electronically to another site for later evaluation. Library patrons who
don’t want to go over their data cap might use a library’s Wi-Fi to send medical records, test results or digital images. For maximum privacy and security, telehealth applications receive and send information using HIPAA-compliant software.
Passive telehealth refers to interactive, educational web content; digital knowledgebases and software applications that help people understand, prevent, treat or recover from threats to their physical and mental health. Few entities are as competent as libraries for making knowledge easy to find and sort through.
There are at least five primary ways to impact health care delivery through telehealth at libraries:
- Reinventing the doctor office visit
- Eliminating frequent travel to doctors
- Turning library parking lots into high-speed stations connecting trauma patients to emergency rooms
- Expanding mental health care locations
- Improving senior health care and seniors’ ability to age in place
Each telehealth discipline could impact broadband infrastructure as well as marketing.
Certain types of medical conditions are more conducive to telehealth in a library setting than others. Dermatology, ophthalmology and general preventative health video consults should be effective.
“Things that require information exchange only are perfect for a library experience as well as telehealth treatment that is visual, such as a [skin] rash,” says Dr. William Payne, an orthopedic surgeon at Franciscan St. James Health/Specialty Physicians in Illinois. Dr. Payne also markets a telehealth application.
“I believe sessions that are conversational, such as talking to a counselor, a health coach or a psychologist, could be easily handled in a library,” says Payne. “And depending on how sophisticated a library wants to be and who it partners with, diagnostic tools could be available to monitor certain conditions, such as hypertension.”
Creative Telehealth, Broadband Vision
Now is a great time to have a telehealth and broadband vision interlaced with creativity, fortified with the belief that people can make a difference in the battle for health care equity while fighting the good fight for digital equity. Anyone can load up some software, but with creativity, people can build something that didn’t previously exist.
Although many libraries are closed during the pandemic, some are building for the future. In 2020, many courts required virtual online attendance. Working with the Indiana Supreme Court and the Coalition for Court Access, Indiana librarians learned effective virtual meeting skills that help them expedite telehealth work.
Done right, a library telehealth center generates excitement, rallying community stakeholders and funding groups because people want to be part of something innovative and transformative. Nothing motivates people like the opportunity to bask in the glow of community accomplishments.
Indiana’s public libraries have become a critical partner with the Indiana Department of Family and Social Services Administration and the Indiana Department of Health in vaccine information distribution, scheduling and registrations. About 1,300 library employees were trained to use software apps and administrative processes.
Libraries reach out and touch almost everyone in their communities across the entire economic spectrum, so imagining telehealth capabilities at work is quite exciting. An “influx of spending for libraries and schools will improve the awareness of digital equity as a fundamental issue,” says Pete Pizzutillo, vice president of sales and marketing at ETI Software and host of the Broadband Bunch podcast. “Our health care, education and judicial systems’ futures rely on getting better digital infrastructure such as telehealth, so when we infuse federal and state budgets with funds earmarked to support that infrastructure, that’s when we will see digital equity improve.”
Craig Settles is president of CJ Speaks. He can be reached at craig@cjspeaks.com. He recently wrote a guide for libraries, telehealth project teams, and broadband stakeholders: “Shhhhhhh! The Doctor Is In – Guide to Connecting Library Patrons to Better Health” (www.cjspeaks.com/reports).
Craig Settles
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