Technology has allowed rural healthcare providers to improve patient care in their communities—but there are still gaps because of a lack of infrastructure.
Real-Time Virtual Support (RTVS), which can incorporate Point-of-Care Ultrasound (POCUS) virtually, among other services made possible by fast internet connections, have been important tools for rural providers in the past few years, especially since the start of the COVID-19 pandemic.
But not all communities are created equal when it comes to having the infrastructure needed to make the best use of this technology.
Slow internet speeds, or patchy connectivity, mean many nursing stations can’t do video calls, so virtual physicians and specialists are patched in over the phone—and that could mean not having the full picture of what’s needed to provide the best care.
Meanwhile, rural healthcare providers and patients who are connected to RTVS virtual physicians and other virtual specialists via Zoom are feeling the benefits.
So what can be done?
Dr. Stefan Du Toit, a general practitioner in Valemount, says low-orbit satellite internet has the potential to make a big impact on rural healthcare.
Dr. Du Toit has been one of the first in his community to order and set up StarLink, the service operated by tech billionaire, Elon Musk. Though the dish is being used in his own home, he says it’s something he’d love to see rolled out in rural healthcare.
The advantage of satellite internet, especially in a place like British Columbia, which has very challenging geography, is that it doesn’t require a huge investment in infrastructure, such as cabling or cell towers.
With low-orbit satellite service, only a dish and a monthly fee is required. And unlike traditional satellite internet, low-orbit satellite internet doesn’t have speed issues.
With traditional satellite internet, which has been available since the late 1990s, data must travel up to the satellite and back (about 72,000 km). This round trip occurs twice for each query you make and adds about a second delay or more to the total time your device takes to communicate with a website or host server. It means it’s not practical to do real-time video calls, like the ones used for RTVS.
Before we had fast internet, we had to do those calls [to nurses in McBride] by telephone. You couldn’t evaluate the patients, even look at them, you’d just have to base your decisions on what you heard … But when we got video calls, you’re able to see a wound, see their clinical picture, you could make decisions with more confidence. As the bandwidth increased, and as these things became available, things improved even more.Dr. Stefan Du Toit
In contrast, low-orbit satellites are roughly 1150 km (about 2300 km round trip) from the surface, making latency issues almost non-existent.
Dr. Du Toit says having fast, reliable internet was key to improving patient care in rural areas.
For example, when doctors in Valemount are on call, they’re also covering the nearby community of McBride. So if a patient turns up in McBride, the doctors need to make a decision on the patient’s treatment, such as whether a transfer is needed, what lab work to order, or what medications are needed.
“Before we had fast internet, we had to do those calls [to nurses in McBride] by telephone. You couldn’t evaluate the patients, even look at them, you’d just have to base your decisions on what you heard. Over the years, we got used to that. But when we got video calls, you’re able to see a wound, see their clinical picture, you could make decisions with more confidence. As the bandwidth increased, and as these things became available, things improved even more,” he says.
But this type of connection is not available in every community.
Dave Harris, the technical lead for RTVS, says people living in rural areas with poor internet connectivity essentially become have-nots simply because of where they live. Harris has been involved in RTVS since the beginning and has long been a proponent of using technology to increase health equity. He’s excited about the potential of StarLink and other low-orbit satellite providers to give rural patients and providers a better life.
“We really, for the first time, have the opportunity to bridge this gap.”
“To put in one cell tower and all infrastructure to support it is at least $200,000 for a tower, plus all the money that’s needed to maintain it. Companies look at that and it doesn’t make economic sense to them or their shareholders.”
And while governments can subsidize this infrastructure, there still needs to be someone with technical expertise to bring the service into homes, he says.
“With Starlink, it’s just a satellite dish, and anyone can put it on their home and then they pay a monthly fee and that’s it.”
Both Harris and Dr. Du Toit can also see an even more exciting opportunity with low-orbit satellite internet.
“If you have a town with 200 people, you might only need four StarLink dishes to serve the whole community. There’s enough bandwidth there that, if you create a mesh network (essentially creating a wifi zone spanning hundreds of meters using a series of repeaters), the whole community can be connected,” Harris says.
If you have a town with 200 people, you might only need four StarLink dishes to serve the whole community. There’s enough bandwidth there that, if you create a mesh network (essentially creating a wifi zone spanning hundreds of meters using a series of repeaters), the whole community can be connected.Dave Harris, technical lead for RTVS
The cost? Likely something in the realm of a $20,000 one-time set up cost for the whole community, plus the monthly fees, according to Harris.
Fast internet is making a difference for health equity in places where it’s available. The way that rural providers can bring ultrasound and RTVS into clinics and hospitals is a game-changer.
Dr. Du Toit says: “I get very passionate and excited about these things because I’ve been a GP for 25 years, so it’s only been in the past five years that we’ve been able to bring a specialist into the room using RTVS. I’ve never had that privilege and it’s huge. I think, for retention of doctors in rural areas and for helping new doctors adjust to being doctors, it’s key. It really decreases your stress levels by 90% just to know you have someone available immediately who can help.”
Having the virtual specialist in the room is also a great help to the wider community.
Dr. Du Toit adds: “Some of these cases I’ve been dealing with, we’d have transferred in the past because we would not have felt comfortable with them. But now you can have a specialist walk you through a situation and manage the case with you. After managing the case you have a wealth of experience. You can read books and go to university, but the way that you really learn and retain that information is to do it yourself. So now, there are more situations that we are comfortable with. And that’s because of the technology that we have.”