Internet Speed and Your Behavioral Health Practice (2020 Update)

The coronavirus pandemic has turbocharged the quest for fast and reliable Internet connections. Many clinic functions depend on robust broadband connectivity such as telehealth sessions, videoconferencing, connecting to servers holding EHR data, and many others.

For many, the virus has uncovered limitations in their clinic’s network, not to mention the extent to which the internet itself can become overwhelmed.

Telehealth problems

When a telehealth session freezes up or you can’t access your EHR, the first reaction is to blame your internet provider or the hosting service you use for storing files. And you might be right. Server farms can run into problems and ISP’s are not always paragons of dependability. Clients or others in a meeting might have broadband issues of their own.

But more often than not, the speed and quality of your internet connection is at the heart of most broadband problems. If the load on your system is greater than the internet resources available to handle it, some sort of delay or interruption is bound to happen. An analogy would be to think of what ensues when heavy rains swamp the street’s drainage system.

When you’re paying a fortune for internet services, it seems inconceivable that the speed and quality of your connection could be lacking. Unfortunately, what determines your online experience isn’t the final charge on your Verizon bill. It’s whether you have a wide enough pipe to handle all the data that might flow in and out.

Internet speed become too slow?

What determines the extent of your usage? Many factors, including the types of applications involved (telehealth and video-conference services chief among the big-ticket items), and the number of users who run those programs at once.

It’s important to be aware that your available bandwidth is shared with all devices connected to the router. So, if you have a 20 Mbps connection and 10 people working in your office, you can think of it as everyone being able to consume 2Mbps before hitting a bottleneck. If many of your staff are engaged in teletherapy, your available internet capacity may quickly fade away. Those video conferences alone can each use over 2 Mbps at a time. The same concept applies if you’re working from your home. Your spouse and children can each be connected via a range of devices that drain your bandwidth:

• computers
• laptops
• smartphones
• game consoles
• smart tv’s

So many factors are involved in determining the average and peak loads on your system, that good estimates of your resources are hard to come by. No one has come up with a meter that provides conclusive statistics about the quantity and quality of the connection at any particular moment. However, you can go to a speed test site like here where you can get statistics for both upload and download speeds.

Upload speeds are important for telehealth conferencing

Keep in mind that, while your download speeds might be ample, your upload speed could well be insufficient in a clinical environment, particularly for the outbound stream from your webcam or in uploading large data files. So you will end up looking pixelated on video calls or have interruptions in your audio or video.

Those upload speeds are often throttled by your ISP to be lower than the information coming down to your router. The internet constantly proves the adage that you’re only as good as your weakest link.

Also don’t be fooled when some of your applications are running well while others can be slow. A music streaming service, like Spotify, “knows” the information that will be flowing in the next 30 seconds of a song. It stores up (buffers) those data so they won’t be subject to brief interruptions or slowdowns. Unfortunately, programs that interact on the fly (like your EHR software), can’t anticipate what data will be interchanged. It can’t buffer those data in the same way in order to avoid disruptions.

What most consultants suggest is to identify your needs according to the number of people in your office (or home). In this article you’ll find a chart that provides rough estimates for the download speeds you’d need based on the number of connected users/devices. Unfortunately, we were unable to find a comparable chart for upload speeds.

Another way of assuring the best internet speed and reliability of your connection is to favor wired (ethernet) connections over Wi-Fi. While it might be much easier to implement Wi-Fi within your office, it has a narrower bandwidth and is far less dependable. Wherever possible, you should use wired connections.

It’s understandable that you’ll get frustrated when an internet-connected application fails to operate smoothly. We all hate it when a video connection drops or is of such poor quality that you can’t even make out the audio. It’s even worse when your providers complain to you that they’re having problems entering their notes or generating e-prescriptions because of internet slowdowns. We’re just advocating that, before assuming it’s the ISP or cloud service, you make sure a contributing factor isn’t the adequacy of your local broadband resources.