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To broaden telehealth services, Md. medical organizations providing internet access

A child receives telehealth services from Kennedy Krieger Institute, part of an expansion of services envisioned by four medical organizations. (Courtesy Kennedy Krieger Institute)

Jacqueline Stone can recall one of the key moments at the beginning of the coronavirus pandemic that made her realize the team at the Kennedy Krieger Institute needed to be doing more to ensure that all patients had access to the same, high-quality telehealth care.

Stone, Kennedy Krieger’s chief clinical officer, had seen a photo of a physical therapist working with a mother and child over a video call, the physical therapist demonstrating exercises that the child was recreating at home, with their mother’s guidance. The physical therapist was watching the scene on a laptop, while the mother and child had called in from a cellphone.

It was a model of what remote physical therapy looked like in the age of COVID-19, but something about the picture disturbed Stone, herself a physical therapist by trade.

“The mom was trying to watch the therapist demonstrate the position, so she could then model and get her child in that position — but only using one hand,” Stone said; the mother’s other hand was occupied holding the cellphone.

Though telehealth — medical appointments held over the phone or through a video call — has gained massive popularity throughout the pandemic as patients were reluctant or even restricted from going to their doctors in-person as COVID-19 surged throughout the country, many still have trouble accessing telehealth. This could be because they live in rural areas without broadband access, because they cannot afford internet access or even because they do not own hardware, like a computer or tablet, to access the internet.

An Abell Foundation report in January 2021 found that 12% of Maryland households lack a tablet, a desktop computer or a laptop computer, and 23% do not have wireline broadband at home. The gap between those with and those without internet is popularly referred to as the “digital divide,” and has come up most often in conversations surrounding online schooling during the pandemic.

Because of this divide, many Kennedy Krieger patients who hail from across the state and even other parts of the country have struggled to reliably participate in telehealth throughout the pandemic. That’s why the institute, which mostly serves children and adolescents with learning disabilities or other disorders, chose to apply for two federal grants to provide new devices and Internet connection to its patients.

The first of the grants came through the Federal Communications Commission’s COVID-19 Telehealth Program, which Kennedy Krieger used to purchase new devices for patients and staff alike. The organization purchased about 400 iPads, which are preferable to phones because they can stand on their own and have larger screens, and 300 WiFi hotspots for families who were previously using cellphones and cellular data for telehealth appointments.

“We feel like that really started to set us up to reach the families that we needed to reach,” said Jennifer Crockett, a psychologist within Kennedy Krieger’s Department of Behavioral Psychology and Telehealth Department.

When applications opened for the FCC’s Connected Care Pilot Program, a $100 million, three-year program aiming to provide the funds for “broadband connectivity, network equipment and information services necessary to provide connected care services to the intended patient population,” Kennedy Krieger again saw an opportunity to improve access to telemedicine for its patients.

The institute was awarded nearly $2 million to provide individual households with either satellite or broadband internet. The project is currently in its early stages and will be accepting proposals from potential broadband vendors in early 2022.

Kennedy Krieger is among four Maryland medical institutions that won Connected Care Pilot Program grants, the others being Johns Hopkins Medicine, Sheppard Pratt and Mobile Medical Care, a federally qualified health center that serves low-income residents in Montgomery County.

MobileMed, which received just under $300,000, is planning to use the funds for three projects: enhancing its ability to text patients, supporting their existing telehealth platform and, like Kennedy Krieger, providing clients with broadband access at home.

The organization hopes that broadband access will not only allow these patients to sign into telehealth sessions but also allow MobileMed to monitor these patients’ conditions and symptoms remotely.

Introducing a new texting service will also help the organization better serve its patients, many of whom prefer texting to other modes of communication.

Though the organization already uses texting for certain things, like appointment reminders, the Health Insurance Portability and Accountability Act severely limits what medical information can be communicated over text. Using a secured, HIPAA-complaint texting platform — MobileMed is using an application called OhMD — will expand what can be sent over text, allowing the team to contact clients about more personal health information.

“The advantage is one that you would imagine; it’s an easy way to connect to patients that are hard to reach. Texting is used by our patients much more than email, and, frankly, it’s much more convenient and useful than voice, as well,” said MobileMed Executive Director Peter Lowet.

Sheppard Pratt is also planning to provide broadband internet access to its patients, primarily targeting those living in group homes in Baltimore, Baltimore County and Frederick County. In total, the organization, which provides mental health and psychiatric care, is hoping to provide 600 with internet access. Sheppard Pratt will also use the grant, which totals almost $1.1 million, to upgrade some hardware, such as monitors and cameras, used in virtual mental health services.

Though many patients are now more confident coming to in-person doctor’s appointments than they were at the start of the pandemic, these organizations are confident that improving telemedicine services will be important long term.

At Kennedy Krieger, for example, families frequently come from across the state to get the specialized care the organization offered.

“Thinking about if you live in, for instance, Princess Anne, Maryland — that’s a full day trip. You pack up, if you have other children, you put them in the car as well, you take off a day from work, you drive across the bridge … you get here, you have your appointment, you probably need a meal,” Stone said. “That’s an entire day, a pretty intensive day, for our patients and families.”