How 5G and decentralized healthcare can help deliver more equitable outcomes

The push for decentralized healthcare—extending the care ecosystem beyond traditional locations to the home, retail and community—is accelerating. It’s being driven by myriad factors, primarily focused on extending care beyond traditional sites of delivery and keeping low-acute patients out of (and away from) hospitals. According to PWC, “Medical and tech innovators and start-ups are disrupting the market, and care models are being reimagined, giving rise to remote and retail care locations.”

Decentralized healthcare can address equity in care access, improve efficiency and quality of services, and bring valuable care services and resources to vast populations, especially those that historically have been low healthcare system utilizers.

Telehealth has been a leading strategy driving this pivot toward decentralized care. It relies on various technologies to connect patients with care services, providers, and resources not readily available in their communities.

According to the  Association of American Medical Colleges (AAMC), “The U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years,” as reported in The Complexities of Physician Supply and Demand: Projections From 2019 to 2034.  The AAMC reports that physician shortages hamper efforts to remove barriers to care. If populations that are underserved by the health system had health care-use patterns similar to populations with fewer access barriers, the U.S. would be short between 102,400 and 180,400 physicians.”  It’s also reported that in the next five years, 35% of the physician workforce will be of retirement age.

In addition to the physical shortage, there are other factors affecting patients’ access to care.  Traditionally, a patient might schedule multiple appointments at various healthcare offices that could be on opposite sides of their town or city, requiring travel time, time off work, and potentially long waits in office waiting rooms.  People without a car or access to public transportation have a harder time accessing health services. In fact, up to 30% of patients of all ages can experience some type of transportation barrier to care.¹

According to AAMC, with fewer doctors choosing to practice in rural areas, residents may have reduced access to specialists which could mean they are less likely to receive chronic condition screenings. This is particularly true for older adults with low mobility as well as low-income individuals who live in cities without transit systems.

Accessing health services can also be challenging for people who work in occupations that do not provide paid time off work. If taking time off for a doctor appointment means earning less—or potentially losing their job—they may decide to skip necessary care, such as preventive screenings. In fact, compared to employees with paid sick leave, workers without it are three times more likely to forgo healthcare for themselves and twice as likely to skip it for family members.² These choices can lead to more significant future disease or health complications. 

Communication is an important factor in establishing trust during the doctor-patient relationship. Language barriers pose many challenges especially in terms of achieving high levels of satisfaction among medical professionals and patients and the ability to provide high quality healthcare.

It is not only important that people can access healthcare, but that care is provided in a manner that best suits specific populations.

According to the Congressional Budget Office (CBO), many uninsured people do not enroll in coverage because of the cost. This means less access to primary and specialty care doctors, the latest medications, and up-to-date treatments. Without health insurance, they must pay out-of-pocket³ when they seek medical care, which can be cost-prohibitive. Historically, if they pursue healthcare, many choose the most expensive option—the emergency room.

This is one reason why less than one-sixth of emergency department visits result in a hospital admission and why a study in the American Journal of Managed Care estimated up to one-third of emergency room visits could be safely referred to primary care, urgent care or retail settings.

5G can help broaden access to medical treatment by powering decentralized care options such as telehealth services, which allows for medical consultations to be undertaken irrespective of patient and doctor location. Telehealth can also provide greater flexibility around timing of consultations and languages spoken by medical staff. Best practice telehealth platforms support multilingual user interfaces, including non-Romance and right-to-left languages, and offer seamless integration with interpreters, including third-party vendors and sign language interpreters.

The U.S. Department of Health and Human Services noted a 63-fold increase in telehealth use during the public health emergency (PHE) COVID-19 pandemic.  High patient satisfaction accompanied this uptick in telehealth deployment—roughly 95% of patients reported being satisfied with the services they received, according to the Bipartisan Policy Center.4  As 5G connectivity grows in ubiquity and accessibility, though, telehealth could become even more critical to positive patient outcomes.

Simple doctor-patient consultations on telehealth platforms can be done without 5G. However, once treatment involves the use of remote patient monitoring or other IoMT devices, or even the transfer of large data files such as medical imaging, the benefits of combining 5G and healthcare become clearer. An organization operating decentralized healthcare operations requires access to large numbers of devices requiring fast speeds and low latency. A 5G network can provide the bandwidth and throughput to support this scale of operation.  Telehealth could help alleviate many of the significant health equity challenges rural communities face.

Additionally, virtual visits via mobile devices can make it easier for people to get necessary care at a time that suits them.  This could allow for a patient without a car to step away from work during a break instead of taking time off, or help patients keep up with preventive screenings from the comfort of their home on a tablet or other device. Mobile health applications can help provide equitable care because a patient has online access to manage appointments, read educational literature, ask questions, pay bills online, and more.  Benefits for providers can include engaging with patients remotely before they enter a care facility to obtain medical histories, easy rescheduling of appointments, rendering of bills via electronic formats, up-to-date patient profiles and access to EHRs.

One way a decentralized healthcare system can help improve the quality of care for at-risk communities is with the increasing availability of mobile clinics, healthcare kiosks, urgent care, retail clinics, freestanding emergency departments, medical call centers, online patient consults, and other engagements. 

For example, a medical center in Chicago noted a high rate of homeless patients with high blood pressure were utilizing their services. By integrating their electronic health records (EHRs) with hospital kiosks spread throughout the community, patients had easier access to health services.  Data collected at the kiosks could be shared with the medical center to decrease the need for hospital visits.  

This type of decentralized healthcare infrastructure requires near real-time sharing of data that can benefit from 5G's speed and low latency.  Further, staff operating in the community will require a level of connected mobility that Wi-Fi cannot provide. According to HIMSS Market Insights research,⁴ in 10 respondents consider 5G a critical form of communication in providing patient care.  Also stated in the same research, 5G can make a significant difference in relieving clinician burnout, already a serious issue in healthcare that was further exacerbated by the pandemic.⁵

Many of the barriers to accessing medical treatment also apply to accessing pharmaceutical services. In both rural and urban areas, pharmacies have limited hours.  Language barriers could result in the misuse of medicines. 

According to the CDC, some factors that affect a patient’s medication adherence may include:

• Medication cost
• Busy schedules that make it hard to remember to take medications consistently
• Ease of scheduling appointments
• Time needed to schedule and attend appointments
• Ease and comfort level of communicating with the pharmacist or other providers
• Understanding when and how often to take medications
• Ability to sync medications and receive automated 30-day or 90-day refills
• Health condition severity and beliefs about their condition
• Expectations around possible effects of the medication

Additionally, the CDC reports that these factors may be intensified by a lack of healthcare and pharmacy access in the community.  Pharmacies are also less common in rural areas.

Telepharmacies are another example of how combining 5G and healthcare can provide the connectivity needed to address many barriers to medical equity, including by helping to expand pharmacy services in rural areas. Telepharmacies can also expand service hours, diversify outreach services such as patient education, monitoring and adherence support, and increase the proportion of patients who are 65 years or older and who are non-English speakers.

5G can provide the high-performing network needed for telepharmacies to function effectively, with faster speeds and downloads, increased data capacity, lower latency and greater device density.