Vermont explores having telehealth hubs at libraries

In the five years since the onset of the COVID-19 pandemic, telehealth and telemedicine services have exploded across the country and are continuing to grow in popularity, based on recent findings.

Earlier this month, FAIR Health, a nonprofit that looks to make health insurance and health care costs more transparent, found that telehealth utilization and insurance claims have increased nationally and in every region of the U.S. except the West. The Northeast region saw a 3.1% jump in telehealth claims, and Vermont in particular looking to boost its use further.

Researchers at the University of Vermont received an initial $10,000 grant earlier this year from the university’s Leahy Institute for Rural Partnerships to explore the possible use of the state’s 185 libraries as telehealth hubs.

Known as VITAL-VT, the project’s other partners include the Vermont Library Association, as well as the College of Nursing and Health Sciences, the Larner College of Medicine and the Department of Emergency Medicine at the UVM Health Network. The Vermont Community Broadband Board, which coordinates deploying broadband in the state, and nonprofit broadband advocacy group Vermont Covered are also involved.

The effort is important, as many Vermonters face obstacles to receiving health care either in person or virtually. The majority are in rural communities located sometimes hours away from providers, which are becoming fewer and further between in the state as they struggle with budgetary pressures and often are forced to close. Accessing telehealth is also a challenge due to slow connectivity and gaps in understanding of how to use technology.

But it has many benefits, and this pilot program aims to bring those to more Vermonters.

“Everybody is pretty spread out,” said Robert Fish, VCBB’s deputy director. “This coincides with most of the major health care providers being in Burlington or the larger towns, which makes getting access to good health care very difficult for rural Vermonters. Telehealth reduces the need to do that, it's also access to experts around the world you can connect with. It also saves money for the provider, the outcomes can be better, it's better for the environment, there's less transportation, and it also allows more people to participate in care.”

Using the initial grant, researchers will assess the technology and other resources libraries need to provide telehealth; the community members they need to prioritize for telehealth services; and  health care providers’ needs. Those needs assessments, expected to take a year, would inform which library sites are ready to serve as telehealth hubs and could then be scaled up.

Telehealth has evolved so much that the possibilities in libraries are almost endless, said Roz King, an emergency department nurse, director of the Research in Emergency Medicine Program, and director of the Emergency Medicine Research Associate Program at UVM’s Larner College of Medicine.

That doesn’t just include primary care visits but also appointments with specialists and other medical services. Emergency medicine benefits from telehealth too, as first responders can communicate better from the scenes of an incident and give doctors and nurses an idea of what will be coming through the door at the emergency room.

“Maybe it's a urology clinic that we need, or geriatric health, or perhaps it's an urgent care with walk-in hours,” King said. “We really don't have a good, data-informed idea of what that real need is, and that's what we want to spend the next year figuring out.”

It also will be critical to work out what shape the state’s libraries are in as they consider offering telehealth services, King said. That will require assessing if they have private rooms for consultations and computers with webcams and Wi-Fi. Researchers will also need to document the libraries’ opening hours, which can vary.

Health care providers will be consulted to determine any obstacles and challenges they may face in providing telehealth services at libraries. King said there is also the possibility of having students who are registered nurses but studying for their Doctor of Nursing Practice degree on-site to provide further assistance.

“It's amazing what we can do now, and it's really changed,” King said. “One of the few things we can thank COVID for was really pushing that envelope on what was possible over telehealth. Then there's also the ability to pair it with other local resources.”

Making sure libraries are connected to the state’s fiber network and able to provide broadband speeds is another critical factor. Even as uncertainty swirls around the future of the federal Broadband Equity, Access and Deployment program, leaders in Vermont said they are well on their way to full connectivity, which is only doable with fiber.

“As we’ve been telling the legislature for the past two years, they don't need to worry about getting people connected. We’ve got that covered,” said Christine Hallquist, VCBB’s executive director. “Now, we need to focus on, how does this benefit Vermonters? That's what our focus is.”