Mobile Bandwidth: A Consideration for Telemedicine and mHealth

no network

An oddly under-scrutinized aspect of telehealth, telemedicine, and mHealth, is summed up by the last of those three terms: mHealth. The “m” stands for “mobile,” and mobility requires telehealth services to be rendered over the most broadly available data networks, which usually are not the fastest.

Although this is usually taken for granted with rural areas, this is also often true of heavily populated ones. For example, I live in a fairly populous suburb. However, due to geography, our coverage map for one of the main carriers in the area (mine!) looks like this:

3g v 4g nearby

The salmon and red areas are 4G coverage and the purple is 3G (the light purple is actually data roaming!).  I repeat, this is not a rural area, although it does border on an undeveloped area.  It has been heavily populated for several decades.

For any mHealth / telemedicine deployment to be useful, it will need to be fully functional at 3G network speeds.  This ensures the widest reach to potential patients as well as the most stability for any use while in motion.  I’ll provide an example of each:

First, imagine a household where one of the occupants has a chronic condition and has agreed to use videocalls for check-ins.  As of 2012, the United States has roughly 75 active mobile broadband subscriptions per 100 people.1  This could be as high as 84 this year (2014)2, indicating that even low-income families are potentially indicated as having access to mobile broadband.

The follow up question is, do they have access to higher speed 4G networks?  Do they live in neighborhoods with crowded capacity?  Do their devices have the capability to provide the quality of connection required to avoid a trip to the hospital? (Especially costly in the case of rural/distant patients, but applicable to urban/suburban life as well.)  Even if their usage plan includes 4G LTE/WiMax, do they actually have that reception?  Even I don’t have 4G access at home.

The second example may be illustrated by terrestrial ambulances or air medical services (helicopters, etc.).  If EMTs are in communication with a hospital, sharing potentially life-saving visuals and data, then keeping the call from dropping and maintaining the quality of the call can be extremely important–even when buildings and mountains and such block the towers of the speedier networks.

Hospitals, clinics, ambulance services, in fact, any organization looking to improve patient outcomes and streamline their ability to provide service by use of video communication, should keep in mind that the solution they try needs to have a track record of functioning on 3G.  It needs to be a truly mobile solution, that can perform on a number of devices in that network environment, and under any number of conditions within that environment.

ambulance in flood

  1.  “Active mobile-broadband subscriptions per 100 inhabitants 2012”, Dynamic Report, ITU ITC EYE, International Telecommunication Union. Retrieved on 29 June 2013.
  2. ICT Facts and Figures 2014“, ITU ITC EYE, International Telecommunication Union.
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2 replies
  1. Marjorie
    Marjorie says:

    I have been talking about this with many folks. Is it to be BYOD or should we dedicate some bandwidth to transmission of highly confidential health care information? Very interesting article. thanks!

    • John Robinson
      John Robinson says:

      Hello Marjorie. We’re glad you appreciated the article, and from your email, it looks like you’re looking at the legal perspective. Could you clarify a little? Usually the software or application being used should have some form of encryption (ours is 256 bit AES, decrypted at the endpoints) that ensures security, making consideration of the device or dedicating bandwidth not as important. However, there has been a movement in the Senate to dedicate a portion of the broadcast spectrum bandwidth for first responders. And, depending on use, BYOD can introduce some security issues if the device is saving the data. (For example, while it’s probably okay for a patient to have their medical info on their phone–securely encrypted, of course–you probably don’t want their doctor leaving the hospital with 300 patients’ worth of info on his phone. Of course, there could be cloud services, Apple’s Healthkit potentially being one of them, that can help with this.) Could you tell us more about what you’ve been discussing? What challenges do you see?

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