The last five feet: Connectivity aspects of hospital-at-home

“Your sound and video are breaking up,” has a different impact when said on a Zoom call than in a hospital-at-home (H@H) setting.  

For decades telecommunications experts have been talking about the “last mile” as it pertains to the bandwidth available to a home or retail setting. As we know, even the fastest broadband throughput can become meaningless if it hits copper in the final leg. Fast forward to Wi-Fi where that digital speedbump is reduced, but still not eliminated.   

I’ve run many webinars where we implored the participants to have a direct ethernet connection to avoid the “you’re breaking up” problem in the middle of the broadcast. Even the major networks have this problem with remote interviews using Zoom-like platforms.  

It’s one thing when the connection occurs during a sales report in a remote senior management meeting. It’s another when the dialysis machine needs a reliable feed to alert the nephrologist of a problem when the patient is at home.  

H@H speed and reliability issues

Compounding the need for reliable connectivity is the need for speed in the infrastructure. This challenge has become magnified by the demands that providers have to read very high-resolution images. Because the file sizes of many of these scans or x-rays are so large the need for it to quickly and reliably render on the screen becomes critical.  

The emergence of the new 5G networks which offer a combination of speed and reliability has been a game changer in business and to a certain extent in brick–and-mortar medical enterprises. But rollout into many residential settings is a perfect example of the “last five feet” challenge. In current hospital-at-home systems, there is the challenge of latency, defined as the time between a patient or clinician sending a change of data and its reception by a patient or clinician.  

Security and privacy in H@H 

The other “last five feet” challenge is related to security and privacy. While the link to the provider’s IT infrastructure may have world-class cybersecurity protection, when data gets to the threshold of the home, the change to a consumer infrastructure in older-generation home Wi-Fi systems or in some copper, there is essentially little to no cybersecurity.  

We know how bad actors will infiltrate residential WiFi where absolutely no hospital-quality care is being dispensed. But the security considerations for care where remote monitoring of medical devices is crucial add a complexity that previous-generation home care never had to worry about.   

Despite the challenges, there is a new generation of hospital-at-home vendors that specialize in raising the safety net for patients and families who want to migrate from traditional in-patient care with sensitivity to the last five feet of home infrastructure.  

In addition, the major telecommunications companies are beginning to pay attention to the fact that H@H is more than upgrading residential service to business quality. Some of these services are being described as “aging at home” products that indirectly have H@H applications.    

Hospital at home connectivity equity

With respect to a company that owns the name, the term “connequity” comes to mind.  There is an enormous have-and-have-not aspect to the ability to avail oneself to hospital-at-home care. I’ve interviewed patients who were pooling together their phone card credits to get their grandmother enough bandwidth for a telemedicine call. Now consider the implications of providing hospital-level care in multi-generational housing for those falling below the safety net.    

As with the gold rush of pandemic telemedicine, the game changer will be in expanded reimbursement from payers for those patients and providers choosing a hospital-at-home delivery of care. In many of these models, there will be connectivity riders in much the same way insurers would cover an insulin device or heart monitor.  

Keep an eye out for more from the Digital Health Insights H@H Technology Series and digital events.