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How to Create a Tele-Healthcare Hub

Posted By Craig Settles, Wednesday, January 10, 2018


With the decision to end net neutrality and the pending decision on February 2 to reduce the definition of broadband speed down to 10 Mbps download/1 Mbps upload, communities may be better off looking toward local solutions.

Many harmful effects of net neutrality repeal can end when communities own Internet infrastructure through municipalities, public utilities, co-ops, or public private partnerships. Community ownership can be easier and more profitable when telehealth and telemedicine is a primary goal of the network.  

Unite your broadband team, healthcare stakeholders, public emergency, and telemedicine providers to integrate broadband and telemedicine. It’s one thing to find money to build a broadband network, but think about the fundraising opportunities when the objective is to build a healthcare asset.

Let’s take this discussion one step further. Consider creating a new kind of broadband triple play – aligning hospitals and healthcare institutions, schools, and libraries into a tele-healthcare hub [see diagram].

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 can apply for the Federal and state agencies that have broadband funds, as well as pursuing organizations, foundations, and other entities predispose to funding education, libraries, economic development etc.

The mini network has an additional benefit. Once conduit in the ground it’s not much more expensive to lay fiber strands to address other constituencies besides hospitals libraries and schools. The mini network becomes a foundation for expansion into other areas of the town or county.

How a triple play tele-healthcare hub might work

Ciena Optical RingObviously a tele-healthcare hub is a new idea. But in and of itself, telehealth applications are proving beneficial while more apps continually come online. The key is broadband, as it and telehealth form a symbiotic technology relationship. You cannot great telehealth without great broadband.

John Baker, Senior Analyst Telemedicine and Video at Children’s Mercy Hospital in Kansas City says, “You need good or excellent broadband for your live 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.”

Children’s Mercy uses AMD Global Telemedicine's devices and software to link the main hospital, their satellite hospital, and their general offices nearby. They will expand the technology when they build the new clinic in Junction City, Kansas. The hospital manages three satellite clinics, and the staff visits several rural clinics on a quarterly basis to provide telemedicine services.

“We generate 13-16 gigabit a day Monday-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 1Gbps to a couple of sites, plus a 100 Mbps and a 50 Mbps fiber line."

The main hospital uses a local broadband provider. The clinics are in the Kansas metro area, so 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 caries a commercial hotspot that they plug into rooms at the rural clinics to provides 20 Mbps of cellular coverage. The hospital’s ambulances only provide transportation services between facilities, and each vehicle has cellular wireless antennas and a portable hotspot. 

The ABC’s of telehealth in K-12

How many schools in your school district could integrate within your hub, especially if you get E-rate money from the FCC grant program?

One of the healthcare challenges facing Sevier County School System in Tennessee was how to stop the spread of communicable illnesses that resulted in school closings. "In some winters, the flu could affect as many as 20 percent of 14,000 students, causing entire schools to shut down in an effort to slow the spread of the flu," explained on Don Best, Coordinator of School Health for the system.

In 2009, the system turned to telemedicine. They use video-conferencing hookups and USB-compatible devices for quick exams and recording vital signs. The telehealth platform comes from AMD Global Telemedicine. The County also made sure there would be a nurse for every school.

During a telemedicine visit, a child can be screened, monitored, examined, diagnosed, and treated for everything including ear infections, strep throat, and obesity. The school and Cherokee Health can easily track health and illness trends.

In eight years there have been over 11,000 telemedicine encounters, and they’ve gone five years without a school closure due to influenza. 84 percent of the students treated via telehealth remain in school.

Libraries – a quiet telehealth ally

Libraries reach out and touch virtually everyone in their communities across the entire economic spectrum. Libraries often have the fastest broadband connections in the community.

Libraries can team up with healthcare providers in the hub to offer health and wellness knowledge as well as telehealth applications and services. Similar to privates companies that have healthcare providers schedule onsite telehealth services for employees, libraries could partner to offer these services to library patrons.

Mobile Beacon is a nonprofit that sells small WiFi transmitters called mobile hotspots to other nonprofit organizations. Libraries, the primary market Mobile Beacon sells to, loan these devices to their patrons for any time between several weeks to six or 12 months.

Katherine Messier, Mobile Beacon’s Executive Director, says, “Roughly 5% of our clients are healthcare organizations. Although it’s a small percentage of our client base, 37% of these organizations use our broadband service in direct support of their patients.” Mobile Beacon is pilot testing a program offering their units to clinics and libraries as part of a telehealth service.

The political scene in Washington looks a little bleak as far as broadband goes. However, creative community anchor institutions (with an emphasis on “creative”) can save the day.

Michael J. Watza, head of the governmental litigation and affairs practice at the Kitch Drutchas Wagner Valitutti & Sherbrook law firm says, “When communities are willing to commit resources to support theirs and their resident’s Constitutional rights and interests, and oppose over-reaching by industry, we can prevail because in many instances we are simply - right. We just need to stand and fight.”


Craig Settles is a broadband industry analyst and consultant to local governments. His report Telehealth & Broadband: In Sickness and In Health advises community broadband builders to drive broadband and telehealth adoption together.

Tags:  FCC  guest blogger  health  libraries  schools  telehealth 

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Why Community Anchor Institutions Should Care About the Connect America Fund

Posted By Amy Robinson, Thursday, October 12, 2017


Rural Broadband


Universal service has been a core mandate in the United States since 1934, with longstanding programs to ensure everyone could subscribe to telephone service. More recently, after passage of the Telecommunications Act of 1996, the Federal Communications Commission (FCC) created the E-rate program to help connect schools and libraries to the Internet and the Rural Health Care program to bring critical communications connectivity to clinics and hospitals in rural areas.  In 2011, the FCC transformed its existing high-cost program to subsidize voice service into the Connect America Fund, with the objective of maintaining and extending fixed and mobile broadband service to homes and small businesses in rural communities.

These three federal universal service programs – all of which subsidize the cost of critical communications services – are administered separately, with significantly different program rules, funding cycles, eligibility requirements, and vocal constituencies. It’s time to step back and ask the question of how these programs could work better together to ensure that 21st century communications infrastructure is available to everyone in rural America.

Anchor institutions like schools, libraries and health care providers play an important role in bringing connectivity to their local communities. But advances in telemedicine and education will not be fully realized if rural consumers do not have adequate broadband service at home.  School aged children will struggle if they cannot do their homework. Individuals with medical conditions that require active monitoring – diabetes, congestive heart failure and more – need broadband at home to transmit critical medical data in real time to medical professionals.

That is why local government officials and anchor institutions should be paying attention to the implementation of the Connect America Fund, now and in the years ahead. The FCC is working to hold an auction in 2018 to award nearly $2 billion in funding over the next decade from Phase II of the Connect America Fund to service providers to extend fixed broadband to unserved residential and small business locations, and a separate auction to award $4.53 billion in funding over a decade from Phase II of the Mobility Fund to mobile wireless providers to extend LTE service to rural America. Any entity willing to provide the requisite level of service set by the FCC and meet other requirements can bid in those auctions for the subsidy.

Local leaders should ask: is it possible to utilize funding in a more coordinated way from E-rate, the Rural Healthcare program, and the Connect America Fund to build a business case to serve the entire community? What efficiencies might be gained from building an integrated broadband network for the entire community? Are the service providers that currently participate in any of these FCC’s universal service programs planning to bid in these upcoming Connect America Fund auctions? Who else might bid?

The Connect America funding only will be available in specific high-cost census blocks, and likely not where most anchor institutions are located. Unfortunately, there are practical obstacles to making the various programs work effectively together, in part a reflection of their administration in separate silos and decisions made long ago on the design of each program. But the availability of this additional funding stream for infrastructure deployment in rural areas should not be ignored. It could make the difference for communities working to develop a comprehensive regional strategy to improve broadband access for their citizens.  

To learn more about the Connect America Fund, attend SHLB's Broadband4All CAF Workshop in Washington, DC on November 2, 2017. Tickets are limited so register today!


Carol Mattey is the former Deputy Bureau Chief of the FCC's Wireline Competition Bureau (2010-2017) and Senior Advisor on the National Broadband Plan (2009-2010), where she led teams working on the landmark Connect America Fund and other initiatives to modernize the FCC’s universal service programs. She currently is the principal of Mattey Consulting LLC, which provides strategic and public policy advisory services to broadband providers, governmental agencies, non-profit organizations, and other entities active in the telecommunications arena.

Tags:  Broadband4All  Connect America Fund  USF 

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Broadband Can’t Be Improved Unless It’s Measured.

Posted By SHLB Coalition, Thursday, August 24, 2017

On August 8, 2017, the FCC launched a new assessment of “whether advanced telecommunications capability is being deployed to all Americans in a reasonable and timely fashion,” (otherwise known as the “706 Report”).  This Report is long overdue, as the Report is supposed to be issued annually, but the last 706 Report was released on January 29, 2016.  

The Notice of Inquiry (NOI) properly seeks comment on both fixed and mobile broadband connections. It acknowledges that the two technologies have different technical characteristics and limitations, and that broadband providers choose to market their fixed and mobile products in different ways.  As Commissioner Clyburn notes in her concurring statement, fixed and mobile services are complements, not substitutes.  While some press accountssuggested that the FCC reached a tentative conclusion to equate the two technologies, it only sought comment on this question.  The FCC also sought comment on how the markets for fixed and mobile services differ, and it did not say that mobile broadband access is a replacement for fixed broadband.

To be clear, the SHLB Coalition does not believe fixed and mobile services are substitutes. Students cannot complete homework and seniors cannot apply for government services with just smartphones. While smartphones can help bridge the digital divide for individuals, they do not replace the gigabit speeds provided by fiber or fixed wireless technologies that anchor institutions need.  

Americans are demanding more and more out of their broadband connection.  As anchors seek more bandwidth, the FCC’s expectations should increase as well.  Nonetheless, the FCC proposed to maintain its existing speed benchmark of 25 Mbps download and3 Mbps for upload (25/3) for fixed broadband, which were adopted in 2015. Significantly for schools, libraries, and other anchors, the Notice also seeks comment on other potential benchmarks.  (see para. 12).  This provides the SHLB Coalition and others a chance to support establishing or improving the benchmarks for anchor institutions.  The 706 NOI discusses the broadband situation for schools (as is statutorily required) but does not discuss the broadband needs of or benchmarks for other anchor institutions.  As the saying goes, you can’t improve what you don’t measure.  The FCC established some benchmarks for schools and libraries in the E-rate program.  But there are no similar benchmarks for other anchor institutions, such as health clinics, community colleges, etc. 

Establishing benchmarks for anchor institutions, even if preliminary, could help to draw attention to the needs of all anchor institutions for better broadband.  Anchor institutions are the “third leg of the stool” for a healthy broadband ecosystem (in addition to business and residential), and ensuring that health providers, community colleges, public media, public housing and other anchors can obtain adequate broadband is important to ensuring that broadband is “being deployed to all Americans.”  If the FCC uses this proceeding to broaden its metrics to measure anchor institution broadband, the result could be significantly better broadband for all.

Tags:  706 Report  FCC 

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Don’t Make Applying for E-rate Fiber Even Harder

Posted By SHLB Coalition, Thursday, July 20, 2017

Applying for E-rate funding is not simple, especially for applicants seeking fiber-based services.  Applicants must have an in-depth knowledge of dark vs. lit fiber, self-provisioning, and special construction, and that’s just the beginning.  The vast majority of schools and libraries have to hire consultants to guide them through the labyrinth of E-rate rules and procedures. So the last thing we should want is to make the E-rate application even more difficult.

Unfortunately, that is exactly what is happening. E-rate fiber applications are being delayed or denied even though they follow the Federal Communications Commission’s (FCC) policies, past precedent, and the Eligible Services List (ESL). As a membership organization made up of schools, libraries, associations, broadband companies and E-rate consultants, we hear these complaints constantly.

For example, USAC has asked fiber applicants detailed questions about their cost allocation methodologies and the ownership and use of fiber strands.  We are not questioning the need to engage in cost allocation – we respect that E-rate funds should not be used to fund ineligible services.  But it appears that USAC is denying some applications for fiber-based services based on unwritten changes to cost allocation processes and treatment of fiber strands.

This new line of inquiry comes after applicants have followed all E-rate procurement rules and guidance, completed the already exhaustive Program Integrity Assurance (PIA) Review process, completed their budgeting processes and, in some cases, already signed contracts and begun to deploy their networks.   This latest inquiry may even result in attempts—using new guidance previously unknown to applicants—to recoup funds for projects already approved and for projects where the special construction of fiber is already underway. 

We have also heard of instances when USAC has given guidance to applicants that differs from its own training guidance documents. How can anyone be expected to make sense of the E-rate program if the policies are changed without advance notice?

The rules and policies adopted in the 2014 E-rate Modernization Orders are intended to help schools and libraries increase their bandwidth and obtain low-cost fiber services, which will be especially helpful in rural markets.   We encourage the Commission and USAC to maintainn the 2014 rules and policies and to provide consistent guidance to E-rate applicants.

We appreciate Chairman Pai’s ideas to streamline the E-rate application process.  Applying for E-rate funding should be made easier, not harder.  The evolution of the E-rate program is in fact a good thing. But with the evolution, we must approach those changes transparently and consistently to ensure all applicants know beforehand what rules and policies will govern E-rate applications.  We look forward to working with the FCC and USAC to improve the E-rate application process in the future, especially for schools and libraries seeking to upgrade their bandwidth using fiber-based solutions in rural markets.

Tags:  erate  FCC  libraries  schools  USAC 

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