Network Measurements and Optimizations for Telehealth in Internet's Remote Regions

Telehealth allows a healthcare facility in a nearby city to provide healthcare access to remote patients through devices connected via communication channels such as the Internet. Healthcare deserts are regions where residents need long travel or wait times to access healthcare, including primary care and specialist care. Therefore, we expect healthcare deserts to benefit most from telehealth by supplementing healthcare access. However, a reliable and fast Internet connection is necessary to provide stable telehealth access to patients from these healthcare deserts. Internet performance varies based on location, with remote regions having limited and expensive Internet access and low Quality of Experience. An overlap between the healthcare deserts and remote Internet regions will make adopting telehealth in these remote regions challenging due to the high latency, low bandwidth, and limited Internet availability, despite the increased need for telehealth. This paper uses Internet measurements to highlight the nature and pitfalls of the current Internet ecosystem in a local context. It questions the fairness of Internet performance globally in providing adequate telehealth access to the Internet's remote regions. Then it presents our prototype implementations, detailing the strategies for deploying telehealth networks at scale. As a remote region in the Internet, this paper uses Alaska as a use case for the challenges in Internet access overlayed with healthcare access and builds a case for networking optimization for telehealth. We discuss leveraging network softwarization innovations to make the Internet more flexible and high-performing for latency-sensitive applications such as telehealth.