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Libraries and Telehealth Tackle Health-Care Gap Full Force

With federal funding for broadband in the pipeline, anchor institutions like libraries are well-positioned to make themselves available to increase patron access to telehealth services.

People using computers in a library.
Flickr/Montgomery County Public Libraries
Public libraries armed with telehealth soon could be the vanguard of a public health army attacking the gap between those who can access affordable, quality health care and those who cannot.

Telehealth may not be the silver bullet for public health care, but it’s a powerful digital tool that can move people way from the wrong side of the gap — especially inner-city low- or no-income residents, rural populations, seniors, immigrants, the unemployed, and the working poor. Armed with a gig of broadband, anchor institutions like libraries can collectively create telehealth hubs to tackle health-care inequity.

Learning from the past, government agencies are significantly stepping up their funding for anchor institutions’ broadband and other digital technologies, which subsequently makes telehealth possible. On July 1, for example, the Federal Communications Commission will begin a 45-day Emergency Connectivity Fund (ECF) of $7.1 billion in broadband and digital technology funding to support libraries and schools.

In June, U.S. Sens. Michael Bennet, D-Colo., Angus King, I-Maine, and Rob Portman, R-Ohio, introduced the Broadband Reform and Investment to Drive Growth in the Economy (BRIDGE) Act, which establishes the $40 billion Broadband Access Fund, run by the National Telecommunications and Information Administration (NTIA). This will be distributed primarily to anchor institutions in the states, tribal governments, and U.S. territories, likely via block grants. Fifty percent of the funds must go to economically distressed rural and urban areas in “future proof” networks that meet communities’ long-term needs.

“The bill’s call for gigabit broadband for anchor institutions is particularly important, as libraries, telehealth providers and other community support organizations can play an instrumental role in solving the digital divide and extending broadband access to all,” said John Windhausen, executive director for the Schools, Health and Libraries Broadband Coalition (SHLB), of the BRIDGE Act.

For over 20 years, anchor institutions have been critical elements of community broadband networks’ design, partly because these organizations can help finance (through fees) a lot of network buildout. But their key value is driving network usage, subscribers and digital literacy from within their organizations. Anchors can also drive telehealth access and adoption.


Libraries wanting to make telehealth a key element of their services should not skimp on technology, especially considering the government funding on offer. The ECF is supplemented with a $3 billion individual subsidy program that makes additional broadband available for telehealth and other applications. Recipients get $50 a month for Internet access and a $100 coupon for a computing device.

“It’s probable that deploying telehealth might require you to upgrade your Internet or wide area network in your branches, particularly the midsize and smaller library systems,” said Michael McKerley, CTO at Education Networks of America (ENA). “Some libraries may not need to do a major overhaul at all.”

Whether or not they add new broadband capabilities, switches and access points, at the very least libraries must plan to segment their telehealth traffic from the rest of their library traffic — and add plenty of security. Unless they did one recently, libraries need to conduct a thorough network assessment and be prepared to do a network redesign if necessary.

Telehealth also requires enterprise-grade video and audio capacity plus excellent bright lighting. During a telehealth session, a library becomes an extension of medical offices. Clinicians will make critical decisions based on the sound, appearance and perceived demeanor of patrons.

McKerley emphasizes that “it’s not just how much bandwidth; it’s the quality and capacity of that bandwidth — equal, symmetrical download and upload speeds, low latency, low jitter, and extremely low packet loss.”


Portable Wi-Fi hot spots are great for rapid, individual broadband deployments. Several vendors, however, are fighting new hot spots that give libraries and other institutions more freedom and less total cost of ownership.

“On the one hand, mobile hot spots are an incredible stopgap solution while we wait to build out broadband infrastructure,” said Lucinda Nord, executive director of the Indiana Library Federation. “They are a convenient size, it’s easy to deploy them to patrons and the government pays for the units. On the other hand, mobile hot spots are limited in quantity and reach, and should be considered only a stopgap solution.”

A number of vendors, including ENA, are developing carrier-agnostic hot spot solutions. These vendors help libraries and other institutions build their own wireless networks outside of the buildings using the same LTE or 5G technology that cellular carriers use. However, customers build them on a publicly available spectrum so that hot spots are not anchored to one carrier’s proprietary network. Hot spots then become extensions of institutions’ wireless networks that range over multiple miles.

Libraries’ hot spots frequently have long waitlists, and new units are back ordered. We must be realistic in terms of their use in telehealth. Hot spots can be good for scheduled care, such as maternal health, mental health care, post operative care, and preventative health care and physical rehab. Because many libraries limit rental time of laptops and hot spots, however, patrons suffering from chronic illnesses and needing frequent doctor visits will not benefit from this solution.

Libraries should also weigh the cost factors involved with loaning hot spots to patrons. Not only are there monthly service fees, but also maintenance and replacement costs.“Some companies require payments for the units and then a monthly service fee while others simply require a monthly fee,” Nord said. “We have had some libraries actually discontinue using mobile hot spots based on costs and loss rate.”

As communities become familiar with the various benefits of telehealth beyond just the occasional video doctor visit, they will begin to realize significant benefits in the overall health of that community. Telehealth always comes back to broadband, and anchor institutions are the key to broadband deployments.
Craig Settles assists cities and co-ops with business planning for broadband and telehealth. He has surveyed economic development professionals nationwide about the impact of telehealth and community broadband, and offers guidance for federal grant proposals for broadband, telehealth, or other digital projects.