Startup Insider: 4 questions with swyMed CEO Stefano Migliorisi on rolling out telemedicine to remote areas

Interest in telemedicine is growing, with the majority of hospitals leaders citing remote care as a priority, according to a May 2017 survey. However, in regions of the U.S. with limited internet access, providers may struggle to connect patients to these virtual resources.

Thirty-four million people, or 10 percent of all Americans, lack access to broadband that meets the Federal Communications Commission's speed benchmark, according to the agency's 2016 Broadband Progress Report. This disparity is pronounced in rural areas, where 39 percent of residents don't have broadband meeting the agency benchmark.

Five years ago, Stefano Migliorisi founded the telemedicine software company swyMed to bring remote care to areas with limited broadband infrastructure. The Lexington, Mass.-based startup develops telemedicine equipment for rural and isolated areas that often face issues related to internet connectivity.

"Telemedicine is great, until you lack the bandwidth to make video and audio work reliably," says Mr. Migliorisi, who now serves as CEO of the company. "We founded swyMed to focus on providing the necessary network infrastructure to make telemedicine possible in rural or low bandwidth areas, where it often is needed most."

Becker's Hospital Review caught up with Mr. Migliorisi to discuss barriers to telemedicine adoption in remote areas and his advice for other health IT companies working with rural communities.

Editor's note: This interview has been edited for length and clarity.

Question: What barriers does telemedicine face in areas with limited internet connectivity?

Stefano Migliorisi: Unfortunately, many telemedicine solutions are ineffective beyond the hard-wired four walls of a hospital or clinic. At swyMed, we built our business model around solving this problem with technology that can deliver quality video encounters, even in the most isolated environments.

The DOT Telemedicine Backpack — which we launched in February 2017 — is a lightweight plug-and-play backpack that allows field care providers to conduct real-time video consultations on the go. It's built with a high-gain antenna array, a 15-hour battery and ruggedized modems in a rugged molded shell, to allow our software's low bandwidth capability to connect patients and medical care teams in even the most remote locations.

Q: How does swyMed fit into the broader healthcare landscape?

SM: The DOT Telemedicine Backpack has given us a tool to extend the reach of traditional telemedicine. Our technology allows providers to assess and monitor patients in an ambulance, facilitate paramedicine programs, and prevent expensive and unnecessary emergency transports. If a patient is en route from one location to another, the DOT Telemedicine Backpack allows the physician to monitor changes in the patient's condition, potentially bypass the emergency department and determine the best course of treatment until the patient arrives at their destination.

Q: What advice do you have for other health IT companies working in rural communities?

SM: At swyMed, we are seeing a simple problem with rural health: As a result of having lower population density, remote areas don't have the volume of patients to support a broad, deep array of services. The question for the industry is: How do you deliver the necessary services in the most efficient manner?  For health IT companies catering to this unique demographic, as a first step we recommend becoming familiar with federal and state programs that focus on extending infrastructure and services to rural communities. These resources can prove an excellent source of ideas and aid if you need to get creative on the business development or partnership side of things.

The worst thing a health IT company can do is go in looking for a quick sale and then immediately run to the airport, so our second recommendation is to always keep in mind that your biggest asset is the people working in the rural settings. These folks are there for a reason, and they care deeply about their communities. They also often know their way around, because they have been keeping the lights on despite the odds that have been mounting against rural health for some time. For this audience especially, it's important to think like a partner who can tailor a solution that meets the local needs. One size definitely doesn't fit all when it comes to rural programs.

Q: What challenges has swyMed faced since launching its low-bandwidth telemedicine solution?

SM: The common theme we have heard from prospective clients about the DOT Telemedicine Backpack is that they love the idea and see the value, but have questions about who is responsible for paying for it. Budgets are tight, so rearranging committed funds to free up money can be complicated in large organizations. Government has such a large influence over the contours of the healthcare delivery system, but it can move at a glacial pace. It may be a while before the obvious efficiencies of telemedicine are broadly supported by the economic incentives. The good news is that everyone can see that a change in telemedicine reimbursement models is coming.

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