More than ever before, innovations in healthcare technology are saving lives. A series of 2015 stories from around the nation highlight the importance of fast, affordable, reliable connectivity in using those technologies to serve patients in both urban and rural settings.
Broadband Speed and Medical Crises
The first story comes from Craig Settles, an expert on broadband access issues. In his line of work, Settles is constantly thinking about, talking about, and writing about the many virtues of broadband technology. But Settles explains that after recently suffering a stroke that required rapid medical attention, he gained a new perspective on the issue.
When someone suffers a stroke, they have three hours to get serious treatment or they often will not recover from its debilitating effects. I was lucky, but...while I worked through my recovery and rehab, a thought hit me: The process of my recovery would have been limited -- if not actually impossible -- had I been living in a small, rural or even urban low-income community without broadband.
Better Broadband, Better Medical Care in Rural West Virginia
The Charleston Gazette-Mail profiles the importance of broadband access at the St. George Medical Clinic in rural West Virginia. The clinic is wedged inside of a deep, wooded river valley, where geographic and topographic challenges interrupt access to reliable, high-speed broadband. In other words, the exact type of rural community Settles had in mind when he wrote about his frightening medical emergency.
But St. George Medical Clinic is different. With assistance from FCC funding, St. George recently laid a 12 miles of fiber optic line that delivers the hospital broadband access, essential to an increasing number of modern medical services. As the article explains:
Prior to installing the fiber optic line, Paul Wamsley, the clinic’s director, said his staff had to work with a DSL connection that only provided speeds of one to three megabits per second (Mbps). But with the new setup, the clinic’s staff and its customers are able to access a patient portal, where they can obtain their medical records, make payments, schedule appointments, request medication and ask for a referral — all online.
As the article also notes, the fiber broadband access at St. George Medical Clinic is the exception, not the rule, when it comes to broadband availability at rural medical facilities in West Virginia. Medical professionals say their patients miss out on access to new healthcare innovations that are not possible in facilities with persistently poor broadband access.
The 10 Gig Doctor
Feature stories appearing in both the Chattanooga Times Free Press and The Chattanoogan tell the story of Dr. Jim Busch, who in October became the first person in the world to get a 10 gigabit broadband per second connection at his home. With 10 gig connectivity, the radiologist and can quickly send and receive massive diagnostic files, enabling him to perform important medical work from home. Dr. Busch pays $299 per month through Chattanooga’s renowned EPB network.
Dr. Busch explains the value of the service to his work:
‘"In my field, fiber optic speeds save lives. Instead of waiting as much as a week or more to get results because radiologists would have to physically go to each location, our patients can get their results in hours or even minutes. When something is seriously wrong catching it as early as possible can be the difference between life and death."
Broadband and the Future of Medicine
Thanks to recent research and development, medical professionals are continuously improving their treatment of patients through the use of a wide variety of cutting edge devices and by employing Internet-based platforms to facilitate more efficient lines of communication. But these devices are only possible because of the high-speed broadband networks that are at the heart of modern digital data transmission demands.
Small and mid-sized communities with municipal networks often find hospitals and clinics are the first entities requesting better connectivity. In fact, more than a few networks were built when strong support from the local medical community tipped opinion in favor of a project.
The medical future is now for communities with access to high-speed broadband. Patients served by clinics with insufficient access to the technology should not have to wait simply because of where they live. Large corporate providers may find no financial justification for developing high-speed networks in sparsely populated rural areas but quality healthcare is a right that cannot be defined by geography. Local communities of every size and location deserve the authority to develop infrastructure to ensure that right.
Jim Baller and Joanne Hovis, two leading voices in the drive to restore local authority, recently spoke with Craig Settles on Gigabit Nation. Baller and Hovis, the President and the CEO, of The Coalition for Local Internet Choice (CLIC) spent about an hour discussing how CLIC is finding ways to help businesses, individuals, and public entities work with elected officials to retain or regain the right for local authority.
Listeners gather insights to working with willing incumbents, developing public-private partnerships, establishing their own networks when necessary, or creating other inventive approaches that work for their communities. Both guests share their many years of experience in helping communities obtain the many benefits of advanced communications capabilities. Baller and Hovis formed CLIC to give voice to the wide range of public and private interests that support local choice and to provide communities practical advice and the tools necessary to prevent new state barriers from being enacted and to remove existing barriers.
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That's a lobby group with members such as Comcast, Cox, Eagle Communications, and Time Warner Cable. The bill was introduced this week, referred to the Committee on Commerce, and scheduled for discussion for Tuesday of next week.
That hearing will now be delayed as the cable lobbyists strategize on a bill that less transparently serves only their interests. As usual, we see the cable lobbyists claiming that municipal networks use taxpayer dollars, despite the reality that most do not.
Much of what I see in Kansas points to Time Warner Cable being behind this - a lame attempt to stop Google Fiber using lobbying power rather than innovating and investing. However, the bill has tremendously negative implications for rural Kansas because local governments are often the only entities that care if their communities have the Internet access they need in the modern economy.
It stretches credulity to think Kansas would pass a bill that would prevent Google from expanding its network in the region. But we have seen a number of states (ahem, North Carolina) pass cable-authored bills that prevent communities from building fiber optic networks if they have anything faster than dial-up available in even part of town.
The cable lobby would consider it a win if they can still push a bill through that would kill municipal networks while allowing approaches like Google Fiber and Wicked (in Lawrence) to expand.
Fortunately, Google has a history of opposing restraints on local authority to build networks and it is part of a business coalition opposing this bill. As with most Americans, that coalition believes any decision on whether a network is a wise investment should be made locally, not in Topeka or in DC.
Craig Settles' had a Chanute official on the Gigabit Nation audio show to discuss the bill and impact on rural Kansas:
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FTTH Council expects the FCC to adopt a test program that will start with a call for those interested to submit "expressions of interest." The reason we are noting this now, when we know so little about the program is that they believe the program will move quickly once it is announced, so those who may be interested should start planning for it.
From what we know, this program will be open to community owned networks and will be largely focuses on smaller markets with preference for networks that will be improving connections to anchor institutions in particular.
Below, I have embedded a discussion between Craig Settles and Alyssa Clemsen-Roberts, the Industry Affairs Manager at the Utilities Telecom Council.
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We were glad to hear our friend, Curtis Dean of the Iowa Association of Municipal Utilities join Craig Settles on his Gigabit Nation Internet Radio show. Listen below to learn more about what local utilities are doing to help their communities thrive in the digital age.
HB 282 sets a very low bar for what is considered "served" - 1.5 Mbps - and prohibits municipal networks from serving those areas while also imposing a new heavy cost on investing in unserved areas.
Mayor Beverly discusses how he and other Georgia community leaders are fighting HB 282 through education. Speaking from first-hand experience, he finds that elected officials often turn from support to opposition when they hear about the incredible success of Thomasville.
Mayor Beverly finds himself sharing the story of Thomasville's victories that are all tied with the network, created in 1999. In Thomasville:
direct profits from the telecommunications utility have eliminated city taxes - police, fire, and other city services are funded through the $2 million+ contributed to the general fund
over 500,000 people in south Georgia have received state-of-the-art healthcare services which could not have been delivered without the incredible capacity of the network over a multi-county area
over 6,000 jobs (including many in the hospital and its clinics) have come to Thomasville through employers that would not have been able to locate there prior to the services offered through the network
about 70 schools over a 10 county region receive network services that Mayor Beverly describes as a "game changer" in educational opportunity
Settles and Mayor Beverly also spent time on what makes Thomasville such a success. The Mayor attributes the community's entrepreneurial approach and their unsurpassed customer relationships. The network and its staff are local and accountable to the people it serves so there is no place for anything other than superb customer service.
The business and residents depend on the Thomasville network. Mayor Beverly, like all the other officals we talk to, can't imagine life in their town without the network. While fighting legislation like HB 282, Mayor Beverly has encountered other elected officials from places where community owned networks are being planned or considered. He says that those leaders all have the same message for the legislature: "Our areas are behind now and if you pass this bill we will always be behind."
Listen to the entire interview on Gigabit Nation to learn about Thomasville's incredible network.
I take a more moderated stance in this discussion than I have previously, in part because we do need to take advantage of this opportunity and because we cannot expect the FCC to suddenly act in our interests when a Congress dominated by big corporations can so quickly punish them for such actions. I think the discussion is worth a listen, though it is 90 minutes.
I am going to be on Gigabit Nation today with Craig Settles, a live call-in show, from 2-3 Eastern time. You can listen online here both during the show and after, when the recording will be made available.
Local governments' use of broadband to improve communication and operations is one of the two main pillars in the financial sustainability model of community broadband networks, wrote host Craig Settles in his first book on the subject. Stakeholders need to pay more attention to this pillar.
The Institute for Local Self Reliance (ILSR) recently released a Public Savings Fact Sheet that spells out in dollars and sense how specific local governments in Florida, Ohio, Virginia and several other states used broadband to significantly cut costs. Christopher Mitchell, a Director with ILSR, joins us to discuss some of these projects.
Mitchell provides assessments of how these various communities identified operational areas broadband could impact. He also offers pointers for listeners who want to replicate some of these successes.
Back in 2010, we reported on SuperNet in Alberta, Canada. We noted how, even though it resulted in significant middle-mile infrastructure expansion, there were still many, many Canadians along the route that were not connected. We drew a parallel between that experience and the focus on middle mile infrastructure via the broadband stimulus programs.
In October, Broadband Communities Magazine carried Craig Settles' article on Olds, a small community in Alberta that overcame the last-mile challenge by working for over 10 years to create that last-mile connection, culminating in O-Net. This town is an inspiration for other communities who decide to take matters into their own hands and find a way to get members connected and engaged.
Settles tells how the process began as a collaborative effort to get organized and revitalize the economy. A technology committee was charged with bringing fiber throughout the county, but the expense was prohibitive. From the article:
"The initial estimate to lay fiber optic cable throughout the county was approximately $80 million [Canadian dollars], well beyond OICRD's [Olds Institute for Community and Regional Development] funding ceiling,” states Joe Gustafson, who was OICRD chairman at that time. “The Tech Committee subsequently refocused on just the town of Olds and its population of just over 8,000, which brought the estimate down to $13.5 million, or about $3,140 per premises passed.”
The story goes on, taking us through several stops and starts the community experienced when working with private providers:
“To date, few incumbents see value in working with a community on a network such as this,” states Craig Dobson, currently the director of Olds Fibre Ltd. (OFL) and initially a consultant for the institute. “In essence, they believe strongly in facilities-based competition and appear to be threatened by market- based services competition that open- access networks enable.” Open-access networks rely on service providers for revenue – without them, the networks are not sustainable.
After working with the private providers to no avail, the organization decided to build the network themselves. The community next tried to work with a partner that would manage the network while the town retained ownership but even that partnership fizzled. OICRD remained the nonprofit organization that owns the town's for-profit network manager, Olds Fiber Ltd (OLF).
The results have been favorable:
Owning its network enables a town to make business decisions that are in the best interests of its community. By having a well-managed, community-owned enterprise, a town such as Olds could retain the millions of dollars that other- wise were leaving the community every year for voice, Internet and TV services.
OICRD, a nonprofit organization, owns the for-profit OFL and provided it with a shareholder loan to build the dark fiber network – which the institute also owns. OFL licenses the network from the institute and is responsible for operating it. OFL sells broadband services and pays the institute a per-subscriber fee based on a formula that enables OFL to generate enough money to cover operating expenses. The institute uses the revenue from these fees to fund community economic development projects.
Local leaders find that the province is giving communities room and opportunity to be self-reliant in achieving connectivity. Olds received a government loan that covered some of the initial costs and OFL President/CEO Lance Douglas told Settles:
“The province is shifting toward a policy of letting communities take responsibility for their own economic and social development. Our community said, ‘We’ll take the risk.’ And government basically said, ‘Take your taxes back and build away.’”
Services from O-Net vary and, while triple-play packages are available, the network makes it easy for new applications to be developed (for example, a telehealth application allowing Doctors to interact with patients using their television). There is also a loyalty reward after 36 months of contiguous triple-play service -- they drop the price considerably. O-Net highlights the value of community owndership. From its website:
As Canada's first community owned and operated Fibre-to-the-Premises network is now lighting-up new orders, you are encouraged to support your community and help pave the way for your future, and the future of many generations to come.
We have covered developments in the town of Indianola, Iowa, where the community decided to build their own network in 1998. The original purpose for investment was to use the network to enhance public safety and increase efficiency with SCADA applications. In 2005, however, the network began offering telecommunications services to local businesses. As of October, Indianola Municipal Utilities (IMU) began offering fiber-to-the-home to residents as it gradually begins expanding the use of its fiber asset.
You can now hear firsthand about the network, its history, and how the municipal utility navigated the journey to its next-generation open access network. Craig Settles interviewed Todd Kielkopf, General Manager of IMU, in an August Gigabit Nation podcast. The two discuss IMU's evolution since 1998. They also talked about the unique advantages that exist when a community considering network infrastructure investment already has a municipal utility in place.
Kielkopf tells how the driving factor for the fiber installation was to allow easier management and communication between utilities. When a 1990 franchise agreement with MediaCom was about to expire, the city investigated options. Hopes were that that the city could build a fiber network and MediaCom would offer services over that network, but that vision was never embraced by MediaCom.
Iowa law allowed the city to hold a referendum asking residents for permission to provide telecommunications services through the municipal utility's network. The referendum passed and they created a five year financial plan. Financing was with taxable and tax exempt bonds. The electric utility would build and own the network and a new telecommunications utility would license to a private partner that would offer retail services. Now, IMU and Mahaska Communication Group (MCG) have an agreement whereby MCG provides retail services over the network. While the agreement is not exclusive, no other providers currently use the network.
Kielkopf discusses three distinct phases in the development of the network's current status. First the network connected schools, libraries, government entities, and other anchor institutions. Next, IMU began connecting and serving businesses. Now, IMU is in the third stage of connecting homes. Along the way, says Kielkopf, the utility took its time and proved to the community that the investment was well spent and that IMU could manage the resource wisely.
Money saved on customers' telephone service, the willingness to work to finance installation, and treating customers well, contributed to IMU's positive reputation in the community. Accordingly, the community continues to support IMU's ambitions and goals for new uses of the network. The main objective for the network has been to provide a public necessity while paying off debt service and earning enough to maintain and improve the network. So far, IMU has met that goal.
In addition to cost savings and increased accessibility for Indianolans, IMU works with the local community college as part of an economic development program. Additionally, IMU is planning slow expansion and is committed to finding ways to simplify utilities and save energy for customers with the fiber network.
Kielkopf and Settles also discussed challenges from opposition to community owned networks and the search for local champions to lead efforts. Kielkopf notes that being proactive and knowing where hot button issues may exist before they ignite can make or break efforts.
He also stresses how Indianola has consciously tried to be different than surrounding communities as a way to attract talent and economic development. As one of many bedroom communities in the Des Moines area, Indianola competes with other similarly sized towns for new jobs, residents, and other resources. Kielkopf sees a direct connection between the network and what Indianola has to offer its residents, two thirds of which commute to Des Moines every day. Businesses (and now residents) can't get this caliber of affordable, reliable, and fast broadband in local areas served by the private sector.
Lastly, Kielkopf notes that successfully managing utilities depends on strong research, testing, and growth from an already existing knowledge base. He suggests that communities recognize strengths and weaknesses and capitalize on them both when venturing into the realm of broadband. The strategy has proved successful for IMU, its partners, customers, and the community.
The new residential service from IMU and its partner MCG includes triple play service of 25/25 Mbps Internet, unlimited local calls, and 105 of the most popular digital television channels for $99.95. For an additional $10, residents can upgrade to 100/100 Mbps. Stand alone Internet service is available for as low as $39.95 for 25/25 and double play packages (data and phone) are also available for as little as $49.95. MCG provides a broad range of bundling variety and 25/25 is available for as little as $5 per month in some packages.
Local governments do not favor themselves on taxes or right of ways or otherwise compete unfairly with incumbent telecommunications and incumbent cable companies. To the contrary, private incumbents enjoy a wealth of state and federal subsidies, guaranteed rates of return, regulated rates for pole attachments, etc. In addition, local telephone companies enjoyed years of regulated monopoly status to build positions of dominance they continue to enjoy. To pretend that these local incumbents, with their subsidies and regulated access, need to “level the playing field” to protect a “free market” against local government systems flies in the face of reality.