Dark Web: Telemedicine a challenge with lack of access in Appalachian communities

Photo illustration by Kohei Hara/Getty Images.
Ohio appalachian counties
A map of designated Appalachian counties in Ohio and neighboring states.

Note: This is the third story in a multi-part series detailing the effects of COVID-19 on Appalachian Ohio and how local residents, businesses and health professionals are responding to best serve their region.

Ohio’s governor has expanded the state’s ability to use telemedicine during the coronavirus stay-at-home order, but for some parts of the state, that option isn’t available.

Rural areas like Southeast Ohio have had problems getting connected to reliable and affordable broadband service for years, to the point where a summit came together in 2017 in Washington County to discuss the issue.

But places like Meigs County still have to prioritize their use when they can access the internet, so the idea of adding a doctor’s appointment to their bandwidth doesn’t seem likely.

“The whole western end of the county is pretty much black,” said Meigs County Commissioner Randy Smith. “There are parts of the community where you just could not do that.”

Smith, who is also a church pastor trying to hold his church services on Facebook Live, said some people in the community have to head to library parking lots to get any internet access, and even with access at home, he said his family struggles.

“My sons are trying to do school work, and the three of them can not complete their school assignments. They can’t do them at the same time,” Smith said.

Experts say the future of medicine will include telemedicine, which means full connectivity in the state is a necessity.

“One in 11 Ohioans don’t have access to reliable, affordable broadband,” said Loren C. Anthes, health policy fellow for The Center for Community Solutions. “For rural communities, it goes to 1 in 3 people with access, and that means telehealth options are limited.”

Anthes said the challenge extends to available providers and hospitals, thus cutting off a vital part of the fight to flatten the coronavirus curve.

“Primary care physicians are really going to be the infantry in this war,” Anthes said.

OhioHealth has hospitals and facilities throughout Southeast Ohio, and has been trying to connect with patients in any way they can. The medical system already has online services to read and pay bills and look at test results through MyChart, their patient portal, but they also know they serve people with a lack of connection and computer access.

“All of (OhioHealth’s telemedicine services) can be done off a smartphone,” said Andrea Darby, Vice President of IT and Integration for OhioHealth. “As long as they have access to a smartphone and a phone plan they can get access.”

OhioHealth has noticed they still have lots of patients simply calling in for information and appointments, which they encourage as well. Darcy said in the span of a week, the system had about 7,000 telephone visits.

The Planned Parenthood in Athens has also adapted to the telemedicine needs of Southeast Ohio, with a call-in service to go along with their chat-text services.

Iris Harvey, CEO and President of Planned Parenthood of Greater Ohio, said there has been an uptick in use of their calling service, which gives patients information and refers them to health centers when needed.

While the state adapts to the new orders, public health professionals are definitely feeling the push to bring connected health to everyone that needs it. Anthes said the sudden need to adapt and make telemedicine work should show what the state needs in terms of medical access.

“This pandemic has really underscored just how fragile our safety net really is,” Anthes said. “We need to understand how it was failing before this happened, so…when or if it happens again, we have what we need.”

This article corrects the last name of the OhioHealth VP of IT and Integration.