Rural Matters

Jan 24 2023

Why Does Telehealth Access Matter for Rural Broadband?

One-quarter of Americans live in rural areas, but fewer than 10% of U.S. physicians practice in those communities. This shortage of healthcare professionals in rural areas of our country restricts access to healthcare by limiting the supply of available services.

Residents of rural communities deserve the same quality of care to which their metropolitan peers have access. To compensate for this resource gap, healthcare providers are extending telehealth services.

But these efforts are coming up against an additional resource gap — broadband internet connectivity.

Rural broadband connectivity is essential for telehealth expansion, but of the 61 million people residing in rural areas, only 58% of adults have a reliable, high-speed broadband connection at home. (Compare this to 67% in urban and 70% in suburban areas.)

The debate is no longer whether telehealth access benefits residents of rural communities but what is the most effective and impactful way to connect rural communities to the broadband services necessary to provide telemedicine.

Let’s examine the connection.

Telehealth Expansion Necessitates Broadband Expansion

The lag in broadband connectivity experienced by rural communities comes in many forms, including:

Less robust or fewer types of broadband infrastructure available,
High cost of installing broadband infrastructure, and
Unreliable broadband speeds (required to enable innovations in healthcare).

A telehealth provider sits on a green couch with a laptop sitting on a table in front of her.

A recent study found that only 38.6% of the people who live more than a 70-minute drive from a primary care physician subscribe to an internet connection capable of handling telehealth services.

To expand the reach of telehealth services into non-metropolitan communities, we must begin by laying the broadband infrastructure necessary to offer those services.

Broadband Expansion Empowers First Responders

The expansion of broadband coverage benefits emergency responders as well as the citizens they serve.

First responders are essential to the protection of public health and safety. When they enter rural communities, they require reliable connectivity to communicate with one another and seek additional resources for response.

A blue 6-pointed asterisk sign with the word AMBULANCES on it.

FirstNet has created a predictable network of connectivity in rural communities to empower first responders. FirstNet is a nationwide high-speed wireless broadband network deployed on 20 MHz of high-quality spectrum that is constantly evolving to meet public safety needs.

When not in use for an emergency, the FirstNet network is used for other commercial purposes (though first responders will always have priority over others during an emergency).

Two benefits of the FirstNet and telehealth connection are:

Enhanced communications for first responders to dispatch an ambulance to a location once the call is received by the consumer/citizen (fairly weak connection).
The network provides high-quality wireless service to many previously unserved rural areas across the US. This wireless broadband can support telehealth activities like online doctor appointments when not in use for an emergency.

But local communities often lack the resources necessary to bring broadband to their areas. That’s where the federal government can help.

Federal Expansion of Broadband Connectivity and Telehealth Access

Recognizing the need for rural communities to 1) improve broadband access and then 2) establish telehealth provisions, various federal programs have increased opportunities and support for public health organizations to establish broadband connectivity.

The US Capitol Building at sunset, where federal programs have been created to aid rural residents access affordable broadband internet.

There are a number of federal programs providing pathways to affordable broadband. Below are a few that emphasize rural broadband access:

The Office for the Advancement of Telehealth is working to improve health care in rural, urban, and underserved communities. In particular, their telehealth grant programs promote and advance telehealth services in rural areas.

The FCC’s Connect2Health Task Force (C2HFCC) is engaged in ongoing efforts to provide expert input and information to stakeholders from a variety of states throughout the country about the importance of broadband and broadband-enabled technologies (e.g., telemedicine, remote monitoring, etc.) in health care at various telehealth resource center annual conferences.

The Rural Health Care Program (which the FCC also oversees) provides funding to eligible healthcare providers for telecommunications and broadband services necessary for the provision of telehealth. This program aims to improve the quality of healthcare available to patients in rural communities by ensuring eligible healthcare providers have access to telecommunications and broadband services.

The National Map of Telehealth Resource Centers provides assistance, education, and information to organizations and individuals who are actively providing or interested in providing health care at a distance.

The Rural Health Information Hub has created a list of current efforts providing telehealth funding for rural healthcare providers.

The American Connectivity Program (ACP) is a nationwide initiative that helps households afford the broadband they need for work, school, healthcare, and more.

But access isn’t the end of the story.

Digital Literacy’s Impact on Telehealth

Digital literacy refers to a user’s ability to navigate information and communication technologies to find, evaluate, create, and communicate information. This skill is critical when navigating telehealth — like every other skill set, we can teach digital literacy!

It is not enough to simply equip rural communities with broadband infrastructure. To maximize the impact of broadband expansion, users need to understand how to actually use the internet.

A pair of hands holds a tablet. The screen reads CONNECT and shows different social media icons.

Several initiatives are already in place to improve digital literacy, particularly in rural areas. And some digital literacy programs focus on serving marginalized communities in rural areas.

For example, the elderly community are frequent healthcare users and can benefit significantly from improved access to telehealth, but only if they feel confident and comfortable navigating the resource online.

While telehealth and telemedicine are on the upswing in rural America, there’s still much work to be done before equitable access is the norm. So how can you help?

Bringing the Benefits of Telehealth to Rural America

Telehealth is an effective way to combat the harm of reduced resources in rural areas, but only if those communities are connected to the Internet. Establishing robust broadband connectivity in rural communities will strengthen telehealth services that have a direct, positive impact on rural residents.

But getting to a place where all Americans can access broadband and services like telemedicine will take continued care and effort. That’s where you come in.

Do you or your organization work in telehealth?

Do you work to bridge resource gaps like broadband connectivity in rural communities?

Have you struggled with or benefitted from these services as a consumer?

We would love to hear from you and continue the conversation. When we get together to talk about the impact of programs closing the urban-rural healthcare divide, it helps communities understand successful programs and program pitfalls, among other benefits.

Join in the conversation on Twitter or in our LinkedIn or Facebook groups.

Dec 13 2022

Telehealth and Telemedicine: What Are the Benefits for Rural Patients?

Individuals living in rural communities want to stay there. And why not! Ask most rural residents, and they’ll have a long list of the reasons they love their rural community.

And nearly 80% of rural small business owners agree the quality of life and cost of living is much better in rural areas, according to the U.S. Chamber Technology Engagement Center.

All this is true despite the ways rural communities quantitatively lag behind their metropolitan counterparts — for example, access to healthcare providers like hospitals, primary doctors, and specialists.

Access to healthcare is necessary for a thriving community, and residents in rural areas deserve equal access to quality healthcare. So how do rural areas overcome any gaps in healthcare access?

Telehealth offers impactful methods of providing healthcare and outreach to rural communities.

What Is Telehealth?

The telehealth definition used in this article is the delivery of healthcare to individuals over a high-speed internet connection.

What is telemedicine? A healthcare practitioner speaks to a patient via videoconferencing. The patient is holding her hands up to her throat as she describes her symptoms.

In addition to having virtual meetings with healthcare providers, other types of services include:

telemedicine (the provision of remote medical care via the Internet and video conferencing),
electronic medical record keeping, and
portal technology and videoconferencing.

Remote health monitoring tools such as wearables and biosensors that track and report personal health information have also become commonplace for remote health care.

Combined, these methods of communicating with healthcare providers help close the rural-urban healthcare access divide.

Before we examine the benefits of telehealth in rural areas, let’s talk about rural healthcare in general.

What Does Healthcare Look Like in Rural Communities?

Regardless of community size, access to routine healthcare and preventative care have long-term, positive impacts on a person’s health. Additionally, when healthcare resources are commonplace, a community flourishes.

The outside of a rural hospital, showing the brick facade and vehicles lined up at the entrance.

Rural communities, however, are experiencing barriers to commonplace healthcare provisions. Unfortunately, hospitals across rural America are closing at an alarming rate.

According to the U.S. Government Accountability Office, over 100 rural hospitals closed from 2013 to 2020, forcing people living in those areas to travel farther to get the same healthcare services — about 20 miles farther for services like inpatient care and double that for services like alcohol or drug abuse treatment.

People living in rural communities have limited access to healthcare institutions, travel long distances to receive care, and (because of these factors) often delay needed care until after they have a health emergency. The cost associated with traveling for medical care puts an additional burden on rural patients that may discourage them from seeking care.

Limited access to healthcare can result in poor health outcomes and is a social and economic burden for both the patient and the healthcare system at large.

Advancements in telehealth – and expanding those services to rural communities – can be used to make up for expanding gaps in health services.

What Are the Benefits of Telehealth in Rural Communities?

People in rural America are growing increasingly comfortable with telehealth and telemedicine.

A woman sits beside a child on a couch, holding a thermometer. There is a tablet sitting on the table in front of them as they wait for a telemedicine appointment.

Telehealth is already an effective approach for doctors to monitor their patients’ chronic conditions, like heart or lung disease. Better monitoring can improve quality of life and reduce hospital admissions and deaths from chronic diseases.

Rural hospitals have fewer resources to provide their patrons, such as specialists or outpatient programs. But telehealth empowers rural hospitals to partner with larger hospitals, work with established online programming for outpatients, and connect to specialists in other communities to make up for these gaps in service.

Telehealth resources facilitate communication between hospitals, which impacts patient care through communication, recommendations for ongoing care, organ donation, patient transport, and more.

The CDC recognizes telehealth as a critical resource for healthcare, both now and in the future, especially for providing care specifically to rural Americans. Because of this, the organization offers various telehealth services targeting common health issues common to rural residents.

One example is the CDC telehealth stroke services which connect hospitals in rural areas with telehealth doctors and specialists outside of their communities to improve the outcomes of patients receiving treatment after experiencing a stroke.

In an effort to expand telehealth to institutions, the CDC has created case studies (HabitNU, Inova, and Inspera Health) that describe successful program structure, technologies used, and implementation steps, along with lessons learned.

But every rural resident isn’t comfortable with talking to their doctor without being face to face.

Why Are Rural Residents Wary of Online Telehealth?

Telehealth is a relatively new healthcare field, and some patients are suspicious of its drawbacks.

Two men, a doctor and a patient, sit in an examination room looking at an X-ray.

According to one review of telehealth interventions and outcomes across rural communities, disadvantages of telehealth interventions included having telemedicine visits with unknown providers and technological issues such as loss of connectivity and limited Wi-Fi access.

Rural residents place a high value on members of their own communities and can be wary of meeting with unfamiliar healthcare providers.

However, acceptance of telehealth during the pandemic accelerated to the point that many barriers to telemedicine use – including trust – may have begun to disappear. Furthermore, telehealth is now available almost everywhere, meaning patients can connect to primary care providers with whom they have an established relationship!

However, along with the other limitations and challenges of telehealth, we can’t forget that the foundational requirement of affordable, accessible broadband and cellular connectivity remains an obstacle.

So, where do rural areas go from here?

Telehealth in Rural Areas: What’s Next?

As telehealth improves, individuals across rural America are empowered to seek healthcare providers more often, preventatively, and consult specialists that meet their unique needs.

One review concluded that telemedicine in rural areas decreases travel time, improves communication with providers, increases access to care, increases self-awareness, and empowers patients to manage their chronic conditions. These benefits are critical to residents in rural communities.

Rural providers also benefit from telehealth as institutions are empowered to expand their provisions by connecting their patients to telehealth resources, decreasing missed appointments and patient wait times, as well as improving patient care quality.

While limitations of telehealth exist, the field is quickly improving and expanding patient care across the country, with unique benefits available to rural communities. Conversations about the impact of programs that close the urban-rural healthcare divide help communities understand successful programs and program pitfalls.

Do you or your organization work in telehealth? What is your experience with telemedicine? We would love to hear from you and share additional resources. We invite you to share your experiences by commenting here and visiting us on Twitter (@RuralRISE).

Apr 13 2021

Broadband Funding is Coming. Now What?

This guest post comes from Maggie Drummond-Bahl, the Senior Program Officer at Maine Community Foundation, working with donors and other partners to improve the quality of life for all Maine people.

More funding is (finally!) coming to support better broadband connectivity. What can we do to ensure that rural and remote communities can maximize this much-needed investment? What role should funders play?

For rural states and communities – and the people and businesses that live and work in them – federal funding through the Economic Recovery Act to expand high-speed internet is welcome news. That news is sweet indeed after a grueling and heartbreaking year of COVID-19 when our ability to connect virtually was more important than ever.

Before we can jump at this opportunity, though, we have work to do. And we need to do it quickly. Here are some thoughts about how we can approach this unprecedented opportunity to become better connected than ever before.

Work to build community capacity

Successful broadband expansion often starts with a few committed champions, much like entrepreneurial ecosystem building often begins with a few key connectors. Champions can identify and recruit others to create broadband committees or working groups and help launch a conversation.

Two women sit with their backs to the camera at a community event.

Bolstering these local and regional planning efforts can help educate community members about what they need and what goals they share as a community.

Local efforts can, with limited resources:

Conduct community surveys,
Host meetings,
Engage with local organizations, institutions and businesses,
Develop maps,
Talk to providers,
Evaluate options, and
Eventually make progress toward implementing infrastructure.

All of these steps are essential, so the community knows what it needs and wants – and more importantly why – long before large-scale funding is available.

Leave no person behind

Successfully building even a fiber-to-the-premise network isn’t enough. We must consider who can afford the service and how to ensure that people can access devices to connect.

Children work on a science project in their classroom. Ensuring equitable broadband access for all children is imperative.

The digital divide is about more than the lack of broadband infrastructure itself — it’s about ensuring equitable access to high-speed internet for everyone in our communities.

Broadband committees, working groups, and community outreach should meaningfully include a broad range of people: students, low-income families with children, older people, Black, Indigenous and other people of color, entrepreneurs working from their homes, and critical institutions in our communities.

We should constantly ask ourselves:

Who is not at the table?
Who is not being served and why?

This pandemic has made painfully clear the inequity in our systems, especially the ability to connect to affordable, reliable, high-speed internet. When we’re all involved in the conversation, we all benefit.

Forge meaningful partnerships

In Maine, a place that prides itself on a certain hearty independence, building trust across institutions, between communities and government, between neighboring towns, and even between customers and providers, has been critical as we move forward.

A group of four colleagues stand together, with two people shaking hands.

A great example is the growth of the broad and diverse stakeholder coalition, the Maine Broadband Coalition. The coalition was founded as an ad-hoc group with scarce resources several years ago to elevate the voices of broadband users in policy and other conversations.

The Coalition now regularly communicates and shares information with over 2200 people — up from just 220 when we made our first grant to the group in early 2019.

The Coalition is also the home of several unifying initiatives including a successful bond campaign in 2020, a new statewide speed test campaign, and an annual conference where communities and partners share their learning and connect with one another.

We’ve also seen great partnerships emerge between social service agencies serving vulnerable populations and digital literacy experts placing hotspot tablets into the hands of people who need them — along with 24-7 technical assistance.

Coordination between funders is another highlight, where our own grantmaking has been informed and bolstered by our state partner, the Connect Maine Authority, and other private foundations and donors.

This has allowed flexible early-stage capital to move planning efforts, community engagement, and digital inclusion. These are just a few examples, but partnership is the secret sauce for all.

Be flexible and entrepreneurial

It has become abundantly clear that the solution for one community is not likely to be the solution for another. We should all strive to be nimble and support varied approaches to increase connectivity.

An illustration of a computer with the words "stay connected" is painted in yellow on a turquoise blue wooden background.

Here are a few examples of what this looks like in communities around the state:

A municipal broadband utility was the right approach for several communities in remote Downeast Maine — and they were the first in the state to try it.
Other communities are pursuing dark-fiber, open-access networks.
Some needed to add WiFi networks on Main Street or upgrade routers at the library for public access.
Still others are opting for an upgrade with an incumbent provider.
And some communities are experimenting with affordability funds to support households that struggle to afford monthly service costs.

One of our strong nonprofit partners in Maine (Island Institute) has developed a playbook for communities that emphasizes an effective community process without predetermining the outcome.

All options should be on the table and partners should constantly adjust to support community needs and priorities.

Funders: now’s the time to stay at the table

As a community foundation with a small percentage of discretionary funding available, we initially did not think we could meaningfully support the work of expanding broadband. If we didn’t have the scale of funding to invest in infrastructure and it is really the role of government anyway, we wondered: what could we contribute?

Other small and mid-size funders might feel the same, especially now that we know significant federal funding is coming for broadband investment. But now is the most important time for philanthropy to stay engaged.

That Maine Broadband Coalition started as an informal, ad hoc network. Targeted investments in organizational capacity have turned a passionate and loosely affiliated group of stakeholders who care about the benefits of broadband into an active and growing coalition.

The end result is a group that elevates the voices of all who depend on good internet in statewide policy discussions, supports communities through a train-the-trainer model, and acts as a convener to deepen our collective understanding of the connections between broadband and the community, economic, and climate resilience work we all care about.

We can use whatever level of capacity we have to support community planning efforts, build the strength of organizations and coalitions doing the work, get ready for emerging opportunities, and raise our voices to advocate for better connectivity.

Now is the time to stay at the table, and pull up a few extra chairs for others to jump in.

On April 15, please join us at the first RuralRISE Technology Summit, a virtual event that will include expert panels, real-world success cases, and networking — all focused on the critical development of broadband and the people and organizations driving the effort.

Register for the Summit (April 15, 2-5 p.m. EST), and make sure to tune in for our fireside chat about the creative partnerships that are helping to close the digital divide in Maine!

Mar 30 2021

3 Crucial Areas of Focus for Rural Small Business

This guest post comes from David Ponraj, founder and CEO of Startup Space (startupspace.us), a social enterprise working with economic and community development organizations across the country to create digital connections to entrepreneurship resources while also providing data and systems for resource management.

Why focus on small businesses? Is the impact worth the effort? What’s in it for economic development organizations?

According to Brooking Institute, “rural small businesses have been found to generate wealth that stays in the community, build local leadership, and even contribute to population health” (read more).

Investing in rural small businesses is good for the entire community, state, and nation.

However, rural small businesses lack the tools and resources needed to build and grow. And the pandemic has not made it easy on our rural communities. 61% of rural small businesses felt unsupported by federal government policies, according to the “Principal Financial Well-Being Index” survey of business owners.

If we want to bring back rural America, we need to focus on supporting rural small businesses. Some of the key areas of focus:

Access to Capital
Access to Broadband Internet
Access to entrepreneurship resources

Let’s take a closer look at each of those three areas of focus.

Access to Capital

Small businesses everywhere struggle to find capital that can fit their needs in terms of speed, cost, and total amount of capital.

A marble building facade reads The Union Banking & Trust Co.

Red tape, high interest rates, and lack of microloans force small businesses to turn to loan sharks and online lenders who engage in predatory lending.

According to the Federal Reserve, 40% of rural counties lost community bank branches between 2012 and 2017. This sets the small businesses back even before they start. If entrepreneurship is about wealth creation, then access to right-sized capital is essential to creating value for the small business owner and enabling them to earn a living.

Access to Broadband Internet

An example of support, one Southern Virginia town is leveraging creative partnerships united by its fiber network to boost the creation and development of its small businesses.

In partnership with Microsoft TechSpark Virginia and with state support, Mid-Atlantic Broadband founded the SOVA Innovation Hub in 2020. This 15,000 square-foot nonprofit center for innovation and entrepreneurship features coworking and meeting space, entrepreneurship and digital skills training, and access to technology experts and experiences.

Three women in masks are seen sitting inside the newly opened SOVA Innovation Hub space.

The partnership envisions the community hub will spark economic transformation in the small Virginia town of 8,142 that was once reliant on tobacco. The hub is the first new building to open in downtown South Boston, VA, in 40 years.

The strategy for the South Boston ecosystem outlines six key goals:

Connect entrepreneurship resources
Support existing business growth and innovation
Develop entrepreneurship training programs to nurture aspiring entrepreneurs
Expedite access to capital
Expedite broadband expansion
Fund and facilitate implementation to ensure flexibility and sustainability

In addition to training programs, grant funds are being used to create a virtual hub with digital infrastructure through Startup Space. SOVA’s digital hub on the Startup Space platform enhances access to the nonprofit’s programs and resources, including a “resource compass” to help entrepreneurs navigate all of the resources available through regional support organizations.

The digital hub makes entrepreneurship and business support services and resources available on-demand through the SOVA website or through an application that can be downloaded on any mobile device.

It is the community’s “one-stop shop” for entrepreneurship and helps SOVA behind the scenes to organize the local ecosystem.

To drive long-term development of the rural entrepreneurship ecosystem, the GO Virginia state board awarded the nonprofit partnership a major grant to support entrepreneurship training, youth entrepreneurship, and increasing access to capital.

Access to broadband is fueling this innovation; creative partnerships are helping to realize its full potential to achieve economic growth. It’s a compelling point of reference for rural economies to develop strong entrepreneurial ecosystems (more on local strategies from Main Street America and the Brookings Institution).

Access to Entrepreneurship Resources

Small businesses everywhere need access to the resource community to start and grow their businesses. We launched Startup Space in 2018 with the singular focus of better connecting small businesses to resources in the community.

A graphic courtesy of Startup Space shows a man with white hair standing in a garage, with text reading "Unlock Opportunities. Create equitable access."

In rural communities, this problem is exacerbated by the fact that resources are often distant and the density of business services (for example, lawyers, accountants, and web developers) is sparse or located hundreds of miles over in an urban community.

This creates a unique challenge for rural entrepreneurs who need the same support network as their urban counterparts to build a thriving business.

We countered this by mapping the local ecosystem and broadening the radius to help rural small businesses easily find the resources they need. We also focus on giving select resources within the community a clear designation so the intended underserved entrepreneur can easily find dedicated resources and support.

Technical assistance can also be hard to come by for rural entrepreneurs. By providing a virtual platform, we can bridge the divide and bring some of these resources right into the home of the small business owner.

When technical assistance is combined with access to capital, small business success rates go up dramatically.

Investing in What Rural Businesses Need

So what’s next for rural America? And what can your organization do to help support local businesses in these three key areas?

We are doing our rural small businesses and our nation a disservice by not recognizing the unique challenges and opportunities that exist in rural America and allocating appropriate resources to quickly address these challenges.

Rural small businesses are the backbone of our rural economy and if we want a strong and vibrant economy, we need to invest in building out the infrastructure that rural communities need. (Read more about why rural America isn’t fully connected yet.)

This April, join us at the first RuralRISE Technology Summit, a virtual event including expert panels, real-world success cases, and networking — all focused on the critical development of broadband and its utilization in rural economic ecosystem strategies.

Register for the Summit (April 15, 2-5 p.m. EST), followed by a social hour hosted by our team at Startup Space.

About Startup Space
Startup Space is a leading community platform that helps connect entrepreneurs to resources in their communities while also providing data analytics and management systems for community builders. For more information, visit https://www.startupspace.us or contact us at media@startupspace.app. The podcast, “Breaking Down Barriers,” featuring entrepreneurial ecosystem builders, is available at: https://startupspace.captivate.fm