By its recent broadband policy decisions, or intent thereof, the FCC majority has proven itself an adversary of consumers, small businesses and local governments. An increasing number of municipalities, public utilities, co-ops and local ISPs are exploring avenues for getting community-owned or controlled broadband networks.
Communities cannot afford to continue to produce yet another feasibility study that just sits on a shelf while stakeholders try to determine what to do next. For the health of your broadband plan, maybe your community should turn to telehealth.
Current conventional wisdom that governs many broadband plans is that communities need to build these networks to ensure local economies stabilize or advance. It’s proven that many local companies in underserved areas need better broadband if they are to stay in the community. But how to attract new companies?
Frank Maddux, nephrologist and co-founder of Gamewood Inc., an ISP that joined the Danville, Va., public utilities broadband network, feels economic development has moved from a “value proposition” to the “expected amenity.”
“Not having broadband makes your community less desirable to businesses planning to relocate,” Maddux said, “but it doesn’t necessarily make you stand out from cities that also have broadband.”
“Some find more interest among community stakeholders for using broadband for telehealth, and its subset telemedicine, than for economic development,” said John Windhausen, executive director of the Schools, Health and Libraries Broadband (SHLB) Coalition. “There can be several reasons, starting with the fact that almost everybody is affected by health care.”
Telehealth requires high-speed quality Internet access. John Baker, senior telemedicine and video conferencing network analyst at Children’s Mercy Hospital in Kansas City, Mo., said, “You need good or excellent broadband for your telehealth services to be useful. When I came on board three years ago, our director of telemedicine had done a lot of research and determined that we needed to accelerate our efforts and our bandwidth.”
“The main medical disciplines that have adopted telemedicine historically have been tele-stroke, mental health, and dermatology,” said Eric Bacon, president of AMD Global Telemedicine. "Woman's health, particularly in underserved and rural areas, is a growing application.” Some consider women’s health care as No. 4 on the list that telemedicine can impact.
“I concur with AMD’s assessment,” said Dr. Jon Belsher, board member of Partners Urgent Care. “I expect a tidal wave of activity in the area of tele-mental health over the next 10 years. There is a severe shortage of specialists, an overwhelming need for mental health services and a high probability for successful patient outcomes.”
General health care, telehealth, and telemedicine delivery can make a strong financial business case that justifies community broadband investment, and makes it easier to raise money. Community leaders, health-care stakeholders, and telehealth application users should conduct needs analysis that strengthens the business case.
A blog post by Sherie Sanders of eCivis highlights the dire state of rural hospitals. “According to the National Rural Health Association, more than 75 rural hospitals have closed since 2010, with 673 at risk of meeting the same fate,” she writes. “That could leave up to 11.7 million people with nowhere to turn.”
Furthermore, about 20 percent of the U.S. population — more than 50 million people — live in rural areas, but only 9 percent of the nation's physicians practice in rural communities, according to the Bureau of Health Professions.
Only 62 percent 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. There are similar statistics from low-income urban communities, such as 40 percent unconnected in Detroit. A report by national and local advocacy groups says, “AT&T has withheld fiber-enhanced broadband improvements from most Cleveland neighborhoods with high poverty rates.”
Additionally, “over 70 percent of small businesses, which include small health-care clinics, have less than 4 Mbps upload speed,” according to data collected by Strategic Network Group.
Children’s Mercy uses AMD Global Telemedicine's devices and software to link the main hospital, their satellite hospital, and their general offices down the street. They will expand the technology when they build the new clinic in Junction City, Kan. The hospital manages three satellite clinics, and the staff visits several rural clinics on a quarterly basis to provide telemedicine services.
“We generate 13 to 16 gigabits a day Monday through Friday,” Baker says. “There are 200 telehealth visits a month that are 30 minutes each. We have a 2 Gbps connection to our main hospital, a 1 Gbps to a couple of sites, and a 100 Mbps, 50 Mbps and a few actual T-1 lines that have 1.5Mbps bandwidth.” However, it’s difficult to do video-centric telemedicine with T-1.
The main hospital uses a local broadband provider, though additionally they have tested Google Fiber. The clinics are in the metro area, so it’s not a true rural setting. The clinics use ISPs located closest to them, but unfortunately, those connections were not reliable or fast enough. The hospital staff carries a commercial hot spot that they plug into rooms at the clinics to provide 20 Mbps of cellular coverage.
Looking at the big picture, it makes financial and political sense to align hospitals and health-care institutions, schools and libraries into a health-care hub. This infrastructure triple play can lay a foundation for building broadband in stages throughout the community.
An engineering design team can create a wired and wireless infrastructure that links all three groups into a mini network and add a number of telemedicine applications and services. Then the community, via the local government, public utility, co-op or a public-private partnership can construct and operate the network.
If a community does its due diligence and advances a strong business case for these health-care hubs, the triple play should open up various additional opportunities for funding, even if the community doesn’t receive government funds.
“Plan and then execute the health-care hub with efficiency,” said Brian Snider, network design practice area leader for engineering and design firm Foresite Group. “Focus on building a network designed for growth, security and reliability. It is also important that the network be built with redundancy in mind.”