Your practice really needs broadband

An unstated fact about the government's recent push for all physician practices to go electronic is that to comply, you're going to need access to a broadband network.

Fortunately, high-speed Internet has expanded in recent years into small towns and rural areas. And another government push is focused on expanding it even further.

There's good reason the federal EMR and broadband programs, both of which were funded under the American Recovery and Reinvestment Act, often are linked, experts say. Not only will having broadband access help physicians qualify for government incentives for "meaningful use" of electronic medical records, as required by the federal stimulus package, but there's also a strong business case for connecting to a broadband network.

A report issued in August by comScore, a global marketing research firm, found that while rural areas still lag behind urban areas, broadband penetration in rural America grew at a faster pace than in metropolitan areas. From the second quarter of 2007 to the second quarter of 2009, broadband penetration in rural areas (fewer than 10,000 people) grew from 59% to 75%. Penetration in metropolitan areas (50,000 people or more) grew from 81% to 92% in the same time period.

There are several types of high-speed networks. The wider, or broader, the bands of frequencies are, the more information can be carried at once. Cable modems, DSL and other fiber optic lines are considered broadband; dial-up telephone modems are considered narrowband.

For physician practices, a broadband network can shorten the time it takes to send an e-mail with a large data file, such as an x-ray or insurance claim, from several minutes to mere seconds. This is important for physicians interested in participating in any type of health information exchange or submitting claims electronically, both of which are likely to be required under EMR meaningful use definitions.

But, experts say, beyond the incentives, broadband just makes good business sense.

"A doctor's time is very precious," said Harry Wang, director of health and mobile product research for the Dallas-based research firm Parks Associates. Having access to broadband can allow physicians to squeeze in quick tasks throughout the day, such as sending an e-mail to a patient. It would add little to the doctor's workload but do a lot to improve communication between doctor and patient, Wang said. But these tasks are more time-intensive with a dial-up Internet connection, he added.

Chris Giancola, principal consultant with technology consulting company CSC, also argued for physicians to adopt broadband.

"If all you're doing is sitting in your practice, and you don't have any communication with any other practices or health insurance companies to check things like eligibility or to submit claims, if you have no connection to the outside world, that's great, you don't need broadband," Giancola said. "But everyone else who actually does need to interact with insurers or other providers ... you need it."

Roger Singh, practice manager for New England Family Health, a solo practice in Framingham, Mass., said the amount of money saved by having broadband makes the decision to invest in it a no-brainer. He is able to submit claims electronically, eliminating mailing costs. He also can check eligibility and co-pays in real-time, allowing him to collect at the point of care.

"The price is not an issue," he said of the approximate $100 per month for service. "It pays for itself."

Performing the same tasks with a dial-up solution would not be impossible, he said, but it would be impractical. The average batch of claims he sends is 3.5 mega bytes of data. "That's hours with dial-up -- if your connection is not dropped in the process."

Not only can physicians save money by going with broadband, Wang said, they also can also create new revenue sources. An increasing number of insurers are paying for online tasks such as e-mails and Web consults, generating revenue opportunities a practice otherwise would be unable to access.

Insurers also are dipping their toes into telehealth efforts, which helped prompt the federal government's initial interest in expanding broadband. The Federal Communications Commission issued a $417 million grant in 2007 to extend broadband networks as a way to promote telehealth. Another $7.2 billion was made available through the stimulus package to expand broadband in unserved or underserved areas.

Lance James, CEO of e-Telmed, a telehealth network provider based in Coconut Creek, Fla., said telehealth would not be possible without broadband. Broadband allows patients in rural areas to access urban networks of specialists and experts. Because e-Telmed's clients are in remote areas where land-based broadband has not yet been installed, many use satellite connections.

Giancola said satellite is an option for any practice that otherwise would be without broadband. But satellites are much better at sending information than receiving it, he said.

The range of available broadband services varies by region. Practices can contact local Internet, cable and satellite providers to see what's available in their areas.

Giancola said that although broadband likely would be required to meet all the meaningful use requirements to qualify for EMR incentives, there may be an appeals process established for practices in regions without broadband access. Exceptions and appeals processes likely will be covered under the meaningful use definitions, which are expected to be finalized by 2010.