What happens when a prime time TV show becomes a potential healthcare policy direction, plus a side helping of broadband adoption strategy?

Good for you, @CityofCleveland. We are working hard to ensure Staten Island joins you in this creative and much-needed effort to push back against hypertension.

Thank you, @cjsettles.@nycHealthy https://t.co/cDQlzLZ2iG

— Jimmy Oddo (@HeyNowJO) December 17, 2019

An episode of the NBC TV medical melodrama New Amsterdam inspired a five-city telehealth pilot project involving barbershops and hair salons. The show’s medical director had a brilliant idea to enlist barbershops in African-American neighborhoods to screen customers for hypertension (high blood pressure), which leads to an overwhelming majority of the 140,000 stroke-related deaths a year.

Cleveland, Ohio, is one of the five cities. Urban Kutz barbershop was early to facilitate a manual hypertension screening program that started 12 years ago. Owner Waverley Willis reports, “90% or more customers discover the first time they’re screen they have high blood pressure. Several customers’ blood pressure was so high they went straight to the ER, and a good number were well on their way to a stroke or a heart attack.”

Once blood pressure data and barbershop customers are online, other telehealth options open up. For example, the Centers for Disease Control (CDC) and private vendors have developed telehealth apps called digital therapeutics to attack chronic illnesses such as diabetes or hypertension by motivating behavioral and lifestyle changes.

Digital therapeutics depends heavily on counseling and access to educational materials, which can require bandwidth and data storage. Customers possibly could start using the app in the barbershops and salons and then move to home access. The telehealth pilots will explore the practicality of these and other possible apps to use in homes around the barbershop or salon.

Broadband. You can’t have telehealth without it!

“In a number of ways, it's the small things that get the most traction,” says Ron Deus, CEO of NetX urban wireless ISP (WISP) based in Cleveland. Explaining symptoms or conditions, determining that there is not a big problem, or conversely there is a problem and they need to see a doctor ASAP. People understand this: their BP level may be a big event, but the knowledge gives them enough value.”

This pilot also explores the roles of barbershops and hair salons in broadband adoption that’s needed to support telehealth. Matt Larsen, owner of rural WISP Vistabeam says, “I would designate the barbershop as a ‘community anchor institution,’ which are the magic words broadband industry people understand. Then you use telehealth to drive subscribers on the network in neighbors around the barbershop.”

Larsen estimates a point-to-point connection to a backbone might cost $1,000-$2,500, but it depends on various factors, and then there’s the monthly fee for the connection. Add a router for the barbershop and then budget $300-$400/user in a rural area for the customer premise equipment (CPE).

Deborah Simpier, co-founder and COO of Althea, a hybrid ISP/community co-op that designed software, an engineering scheme, and business model that enables community ownership. “Because profit is shared by members, focus shifts to how this wireless infrastructure can most effectively benefit the community, such as introducing telehealth,” she says. “This can be a more sustainable solution, especially in the often overlooked low-income or rural areas.”

Silicon Harlem CEO and Co-Founder Clayton Banks says the organization is an innovation center that took over the community’s wireless network, enhanced it, and monetized the infrastructure so that residents would be charged as little as possible. “When you ensure everyone in the community has wireless and wired connectivity, that’s when you can transform healthcare. We’re thankful Harlem Hospital is under our broadband umbrella.” Silicon Harlem is the second pilot site.

It doesn’t take much bandwidth to move blood pressure data from a barber shop or hair salon to a healthcare facility. But as you increase the number of telehealth apps, medical devices, computing devices, educational content, people, or miles in between people, that broadband network has to scale and increase reliability. That means more infrastructure.

“If a person’s experience has to be virtually live and they need ultra-high reliability, speed, and super-low latency, then local mini data centers can alleviate potential downsides,” says Catherine McNaught, Emerging Applications Market Development Manager at Corning Optical Communications. “You don't want to ship data clear across several states to a data center somewhere, crunch it, and send it back. Many telehealth apps rely on cloud computing. It helps when users have cloud functions closer to where the data's being generated.”

New Amsterdam‘s medical director unknowingly makes the combined business case for telehealth and community broadband when he said, “There’s no reason that healthcare has to be delivered in a hospital. In fact, patients are best served in an environment where they are made comfortable. By trusted members of their own community. Hospitals have to go meet patients where they are, not the other way around.”

Telehealth turns healthcare delivery on its ear for the good of patients and their families, healthcare, and insurers. Community broadband owners can financially benefit as well. There is definitely a symbiotic relationship between these technologies. Sometimes, the simplest ideas can reap powerful rewards.      

Craig Settles assists cities and co-ops with business planning for broadband and telehealth. He can be reached at: craig@cjspeaks.com

The Benton Institute for Broadband & Society is a non-profit organization dedicated to ensuring that all people in the U.S. have access to competitive, High-Performance Broadband regardless of where they live or who they are. We believe communication policy - rooted in the values of access, equity, and diversity - has the power to deliver new opportunities and strengthen communities.

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