Telemedicine is a natural fit for rural healthcare delivery. But there’s a problem: Poor network infrastructure in rural areas hampers the application of telemedicine where it arguably is needed most.
One startup, born out of the need for reliable real-time communications for gaming, sees a way out of this problem for rural healthcare providers.
Over the past three years, Agora.io has been developing a global real-time communications infrastructure for voice and video chat that can be embedded in websites or smartphone apps and can run on most devices. This is possible without any plugins or special equipment and, crucially, the infrastructure claims to deliver reliable connectivity even in the face of poor bandwidth, variable cellular connections and Internet traffic jams that quietly degrade video connections.
“Services like Skype and other video chat systems have existed for years, but we saw a real need for reliable real-time communications that could function for mission-critical applications when poor connections and dropped calls were not an option,” said Tony Zhao, founder and CEO of privately held Agora.io, in a phone interview. “A choppy video chat might be okay for talking with friends in India, but it doesn’t work if you want to use the technology for areas like gaming, education or healthcare.”
From this need came Agora.io in 2014, a communications-as-a-service platform that lets individuals and organizations quickly add reliable video chat in a pay-per-use model that’s as easy and affordable as the other cloud services that now serve as basic infrastructure for many organizations.
Agora.io serves a range of industries that need reliable real-time communications, including retail, gaming, human resources and education, among others. But where the technology might be most useful is telemedicine. Specifically, rural telemedicine.
“We quickly found that rural communities needed telemedicine badly, but connectivity was a huge problem,” Zhao said. “Here was this big healthcare challenge, and we actually could solve it.”
Rural communities stand to benefit from telemedicine disproportionately because remote medicine addresses several challenges currently faced by rural healthcare. Declining rural populations, a high percentage of uninsured and elderly patients, an absence of high-margin specialty services that support financial sustainability, and a lack of both specialist equipment and staffing have combined to put great strain on rural hospitals.
Telemedicine can mitigate that strain. The Institute of Medicine for the National Academies has found that telemedicine can drive volume, increase quality and reduce costs for rural healthcare operations through initiatives such as remote consultations, in-home monitoring, outsourced diagnostics and remote specialist consultations. Medical appointments by videoconferencing are faster, less expensive and more efficient than traditional, in-person appointments. This is especially true for follow-up and simple health concerns, where a quick video call can replace hospital or clinic appointments while helping rural healthcare economics at the same time.
Similarly, rural hospitals can address the shortage of specialists through the use of virtual consultations with doctors in larger metropolitan areas. Attracting specialists to rural hospitals is a challenge, not to mention the smaller population sizes that limit the number of specialists rural healthcare organizations can afford. With telemedicine, these problems can be overcome.
But that’s assuming rural healthcare providers can afford telemedicine rollout and reach patients connected by unreliable Internet access. This is where Agora.io technology plays a role.
Agora.io’s platform works by combining proprietary audio and video transmission technology for quality assurance with the latest real-time communications standards. Healthcare providers do not need to invest in any hardware to use the platform.
Rural network connectivity challenges that normally affect video chat are apparently overcome by transmission protocols that dynamically adjust when signal strength and bandwidth constraints vary, and by proprietary video and audio formats that function properly in reduced bandwidth situations. Agora.io then monitors, routes and adjusts connections in real-time by moving video calls through its network of more than 80 global data centers instead of relying solely on the public Internet. The public Internet is adequate for checking email and serving web pages, but can cause delays and hiccups for streaming video.
Complexity and the need for special hardware and software is then eliminated by Agora.io’s use of the WebRTC standard for streaming video, a technology pioneered by Google that lets real-time video functionality embed easily and work automatically on any device with a modern web browser including on smartphones, tablets and personal computers.
The result is telemedicine-grade video chat that can reach rural patients with spotty network connections and is both quick to roll out and easy for healthcare providers to afford. Transmissions are as secure as online banking, too, meeting medical privacy needs.
“Telemedicine is now almost too easy,” Zhao said, laughing. “The biggest issue right now is building awareness that the technology is out there and rural healthcare can use it today.”
Driving home the point, the RUPRI Center for Rural Health Analysis recently looked at 4,727 rural hospitals and found that nearly 66 percent had no telemedicine services or were only in the beginning stages of implementation.