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The Last Five Feet – Connectivity Aspects of Hospital-at-Home Programs

Woman nurse pushing man in wheelchair

It’s different than when we say, “Your sound and video are breaking up” on a Zoom call.

For decades, telecommunications experts have been talking about the “last mile” regarding the bandwidth available to a home or retail setting. Even the fastest broadband throughput can become meaningless if it hits copper in the final leg. While WIFI might reduce that digital speed bump, it’s still not eliminated.

I’ve run countless webinars where we’ve implored participants to use a direct ethernet connection to avoid the “you’re breaking up” problem in the middle of the broadcast. Even the major networks have this problem with remote interviews using Zoom-like platforms.

It’s one thing when the connection occurs during a sales report in a remote senior management meeting. It’s another when the dialysis machine needs a reliable feed to alert the nephrologist of a problem when the patient is at home.

Speed and Reliability

Compounding the need for reliable connectivity is the need for speed in this infrastructure. This challenge has become magnified by physicans' needs for high-resolution images. Because the file sizes of many of these scans or x-rays are so large, the need for it to quickly and reliably render on the screen becomes critical.

The emergence of 5G networks, which offer a combination of speed and reliability, has been a game changer in business — and, to a certain extent, in bricks and mortar medical enterprises. But rollout into many residential settings is a perfect example of the “last five feet” challenges I mention in the title. In current hospital-at-home (H@H) programs, this is the first challenge of latency: the time between a patient or clinician sending a change of data and its reception by the other party.

Security and Privacy

The second “last five feet” challenge concerns security and privacy. While the link to a provider’s IT infrastructure may have world-class cybersecurity protection, this is not the case when data reaches the threshold of a home.

We know how bad actors will infiltrate residential WIFI where absolutely no hospital-quality care is being dispensed. When remote monitoring devices are involved, it is crucial to consider the added security implications for care — a complexity that previous generations of home care never had to worry about.

Despite the challenges, a new wave of H@H vendors are specializing in solutions that raise the safety net for patients migrating from traditional in-patient care to the home.

In addition, the major telecommunications companies are beginning to pay attention to the fact that H@H is more than upgrading residential service to business quality. Some of these services are described as “aging at home” products that indirectly have H@H applications.

Connectivity and Equity

With respect to a company that owns the name, “connequity” comes to mind as the third major challenge. There is an enormous have-and-have-not aspect to the access and availability of H@H care. I’ve interviewed families pooling together their phone card credits to get their grandmother enough bandwidth for a telemedicine call. Now consider the implications of providing hospital-level care in multi-generational housing for those falling below the safety net.

As with the gold rush of pandemic telemedicine, the game changer will be in expanded reimbursement from payers for those patients and providers choosing H@H delivery of care. In many of these models, there will be a connectivity element in much the same way insurers would cover an insulin device or heart monitor.

The ICD Healthcare Network addresses some of these reimbursement issues in the webcast: From the Hill to Your House: What New Federal Legislation Means for the Future of Hospital at Home.

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