Missouri health care providers detail struggles of telehealth access


JEFFERSON CITY, Mo. — Hundreds of thousands of Missourians have met with their doctor through telehealth over the past year, but health care providers said access to the internet is still a problem for patients.

Roughly 20% of Missouri’s population doesn’t have access to high-speed internet, according to the Federal Communications Commission (FCC). Most of those Missourians live in rural parts of the state, which can make it tough for patients to take to their doctors.

“Even with all the changes in technology, broadband is still one of the biggest barriers,” Senior Program Director of Missouri Telehealth Network Rachel Mutrux told a House committee Monday. “These issues create technology deserts, which creates the digital divide between rural and urban areas.”

For the past 18 months, health care providers and patients have relied heavily on telehealth, but for Missourians without internet access, those virtual appointments are no easy task.

“Before the pandemic, BJC did about 4,000 video visits, and in 2020, during the pandemic, we did 190,000,” Dr. Michele Thomas from BJC Healthcare in St. Louis said.

Thomas said BJC is on track to complete about 120,000 virtual doctor visits in 2021.

A handful of lawmakers were back in the Capitol on Monday for a committee hearing on broadband development. The committee was formed earlier this summer with the hopes of using some federal COVID relief money to expand internet access.

Missouri currently ranks 32nd in the nation for broadband access, but there are more than a million Missourians with no access to the internet.

“The most vulnerable Missourians were not able to access these services due to the lack of connectivity and, or the technology ownership,” Mutrux said.

Mutrux told the committee the network started a program offering hotspots for patients in need. The program started in July 2020 and ends later this month. This past June, 8,000 hotspots were delivered to patients.

“Once we started closing our clinics, we started transitioning to video visits and the patients who were doing telephone only because that’s the only way they could do it, those were the patients that they provided the hotspots.”

She also said health care providers are noticing a decrease in no-shows because they don’t have to find a way to the appointment or worry about their job. It also is easier for the doctor or nurse to access medical records and input documentation.

In August, Gov. Mike Parson announced more than $400 million from the American Rescue Plan Act (ARPA) would be allocated to increasing internet access.

Marie Davis, executive treasurer for the Missouri FFA Association, said she visited an agriculture class at a school in Lewis County two weeks ago. Of the 20 seventh-graders in the class, Davis told representatives, only three of them had internet outside of their cell phones, at their parents’ house.

“We suggested to numerous students throughout 2020 and 2021 to seek alternatives sites or local businesses to do their interviews,” Davis said. “How do we make ag education, which we say is hands-on, not hands-on? The other limiting factor with that is how to make virtual accessible to students who don’t have accessible internet?”

Rep. Cyndi Buchheit-Courtway (R-Festus) said she works in a hospital and agrees telehealth is now a key to healthcare moves forward in the state.

“I do see more people miss their appointments all the time just because they don’t want to leave their house or they can’t catch a ride, so I know telehealth is so important to us,” Buchheit-Courtway said.

Besides health care, the Department of Elementary and Secondary Education (DESE) said students also lack internet access. Missourians with developmental disabilities say they too feel the ramifications.

“Without access to broadband and support to use devices, people with developmental disabilities in Missouri could be left behind,” Chris Fagan with the Missouri Developmental Disabilities Council said. “Many programs like food stamps and social security are applied online. If developmental disability communities don’t have access to broadband and a source to use it, even basic needs are hard to meet.”

Carrie Coogan, deputy director for public affairs at Kansas City Public Library, said throughout the pandemic libraries were required to close, but workers stepped up to make sure those without access to the internet could get connected with hotspots.

She told lawmakers roughly 30,000 Missourians in the Kansas City area lack broadband.

Using an emergency federal fund for COVID, Coogan said the library plans to purchase 1,500 more laptops for residents to check out. The next step, making a space available for patients to talk to their doctors.

“Finding HIPAA safe locations where people can go in and have an online conversation with a doctor or a nurse, that’s definitely something that’s in the future for us,” Coogan said.

Health care providers told the House committee that fewer patients are using telehealth this year than last, but it tends to fluctuate with the number of cases.

Members plan to meet again next month before submitting a report to the General Assembly in December.

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