A Match Made in Cyberheaven?

Telemedicine and Community Broadband —

Only 1% of Arkansas stroke victims used to receive a life-saving drug called alteplase (TPA), resulting in the state leading the US in stroke-related deaths. In 2008, the University of Arkansas Medical Sciences used gigabit broadband to link 53 of the state’s 80 hospitals to a telemedicine system to increase treatments to 33% while determining the rest required less serious or no treatment.

Seeing the results such as these, "Some stakeholders are more interested in using broadband for telehealth than for economic development," says John Windhausen, Executive Director of the Schools, Health & Libraries Broadband (SHLB) Coalition. "One reason is that almost everybody is affected by healthcare."

Telemedicine touches many medical disciplines, including mental health, tele-stroke, dermatology, women’s health, and physical rehabilitation. Just about every person from newborns to seniors may have telemedicine influence their lives at some time. Even large companies are incorporating telehealth clinics in their office complexes.

However, access to speedy, quality, and reliable, broadband determines how convenient, affordable, and far-reaching are the telemedicine benefits that communities receive.

An Unhealthy Speed Stymie
Broadband speed can stymie those who need telehealth the most. In fact, only 62% of rural Americans have broadband installed in their homes, according to the think tank New America, and those who do, often pay exorbitant prices for sluggish speeds. In fact, 39% of rural Americans are unable to purchase Internet service that meets the Federal Communications Commission’s minimum standards for high-speed access — 25Mbs/3Mbs — at all. Oh, wait. FCC Chairman, Ajit Pai, wants to change the definition back down to 10/1.

For small businesses, which includes physician practices, "over 70% of small businesses (fewer than 50 employees) have less than 4 Mbps upload speed," according to data collected by Strategic Network Group.

Let’s be clear about definitions. Many people use speed and capacity interchangeably when they discuss broadband. But these words aren’t interchangeable. Even if a residence subscribes to 10 megs of speed between 4:00 p.m. and 10:00 p.m. (Internet prime time), the network’s capacity (how much data passes from point A to B) can make 10 megs per residence a pipe dream.

Telehealth vendors and healthcare providers need to realize that technology now exists to minimize the bandwidth required for video and other applications. However, capacity issues are a problem in both urban and rural areas. Furthermore, data caps are a plague among low-income communities who access telehealth apps on smartphones.

Community-Owned Broadband Can Help
There are over 400 US municipally owned networks, and many munis deliver services that run across these networks. There are an indeterminate number of public private partnerships in various configurations, plus community co-ops, WISPs, and rural telcos. Telemedicine, telehealth, and general healthcare delivery, can make the business case for community-owned networks that justifies the broadband investment.

There are 2 categories of telemedicine applications: live, and store and forward. Live means there’s a real-time interaction between patient and healthcare professional, or between healthcare professionals," states Eric Bacon, President of AMD Global Telemedicine. "These applications often involve a live video feed along with streaming data from applications or devices." The faster the broadband, the better live applications perform.

With store and forward, data such as MRIs, X-rays, and report information, is collected, stored on computing devices, on the web, in the Cloud, etc., and then picked up later for review. Broadband speed may not seem as much of a factor with these applications, but network capacity, reliability, and data security, are still crucial.

When you look at the history of public-own networks, even long before the term telehealth became popular, broadband has made a difference in the quality of healthcare communities received.

In 2001, a decade ahead of the gigabit pack, Springfield, Missouri’s public utility offered a gigabit service over its Springnet fiber network. Very few people knew what gig speed was, let alone worried about the lack of gig applications. But the local hospital understood right away that the killer app was the speed of the connection, according to Todd Christell, Springnet’s Manager of Network Architecture/Support.

The hospital relocated their radiology department, and used their gig connection to link the main facility, the ER, the clinics, and other locations, to send their X-rays to the radiologists "The revolutionary part was the evolutionary path to grow their business through the capabilities of our network, which became an extension of their local area network," states Christell. Regardless of how remote their buildings were, personnel could access and manipulate data at gig speed with low latency. This immediate benefit justified the hospital’s investment.

Another case is Loma Linda, California’s muni network. The town shifted from residential and business sales in 2009 to selling Internet access services primarily to businesses, hospitals, and small physician practices, that connected their 2 or 3 offices. This did 3 things for the community:
1. Helped improve the financial health of existing medical facilities.
2. Increased the number of healthcare facilities AND professionals.
3. Attracted hospitality facilities for out-of-town guests visiting sick relatives.

More broadband-related telehealth projects are in the works, says Konrad Bolowich, Loma Linda’s assistant city manager. "Our hospitals are running several broadband-assisted pilot projects that have great potential for impacting rural hospitals. One involves using telemetry in hotel rooms where patients can stay while physicians monitor them overnight after surgery or other medical procedures. Another pilot is testing how well robots can assist with monitoring and other routine non-critical medical tasks. I believe broadband will soon be able to assist with literally cradle-to-grave healthcare."

The Ultimate Owner?
Perhaps healthcare providers could be the ultimate community owner of broadband infrastructure. "We would love to see healthcare facilities own broadband networks across entire cities." says Lauren Bender, Business Development Manager at Foresite Group. "The citizens of the city they operate in are essentially their patients. The hospitals are not ‘getting into the utility business’ by doing this, they would simply own the infrastructure. Managing and operating the network could all be contracted out to a third party."

Sources
New America Weekly, Edition 173.The Future of Broadband in Underserved Areas. https://www.newamerica.org/weekly/edition-173/future-broadband-underserved-areas/

Daily Yonder. Now Is the Time to Fight for Fast Internet by Craig Settles. October 17, 2017. http://www.dailyyonder.com/now-time-fight-fast-internet/2017/10/17/21864/

Strategic Networks Group. What Kind Of Speed Matters for Broadband’s Economic Development Impact? http://sngroup.com/uploadspeed/