Cleveland Clinic and Cox Communications may have "buried the lead" that is, hidden the most important news deep in a recent announcement of their new collaborative telehealth venture, Vivre Health, which is slated to deliver health services to patients' homes via their broadband Internet connection.
Other than a brief statement from Cox's chief strategy officer, Asheesh Saksena "Fueled by access to broadband, we believe the home will be an increasingly important node within the healthcare delivery architecture and Vivre Health is uniquely positioned to help drive this transformation" the announcement was devoid of detail. And most healthcare IT executives can probably fill in the blanks pretty well for themselves at this point.
But directly following Saksena's boilerplate, Cox offered a "by the way" that may give some insight into how, exactly, the lagging "last mile" in the U.S. may finally be brought up to speed. "Leading its peers and competitors in the industry, Cox recently committed to deliver residential Gigabit Internet speeds to all markets it serves by the end of 2016."
A Gigabit, everywhere in its footprint, within two years. That's huge news, given the mediocre broadband networks U.S. consumers have been offered by the incumbent phone and cable television companies, who have secured a virtual duopoly for themselves in the vast majority of residential neighborhoods in the country. In fact, under its recent re-definition of "broadband" to mean a download speed of 25 Megabits per second and an upload speed of 3 Mbps, the FCC estimates that 55 million Americans, nearly one in five, lack access to advanced broadband capabilities and that figure is probably low. A customer at the end of a suburban DSL line can't figure on much more than a 3 Mbps download and at best a 512 Kilobit upload, no matter how much "up to" malarkey the sales reps spew. Basic cable Internet is another "up to" deal, typically with a 15 Mbps download and 5 Mbps upload limit, depending on aggregate network usage at any given time.
The incumbents have been very successful over the years in stifling competition, both private and public sector. The net result, no pun intended, is that the U.S. keeps sliding downward in global Internet speed. The latest results from Ookla, a speed metrics company, placed us at 26th with an average 33.18 Megabits per second download speed, between Hungary and Bulgaria.
As a matter of public policy, the Obama administration is now championing publicly-financed local networks, which entails overturning laws in 19 states forbidding them, and a cultural aversion in many other places to upsetting the incumbents' apple cart.
But the demands of delivering healthcare services in more economical settings, such as a patient's own home, may be exactly the kind of spur the last mile upgrade really needs. Today's last-mile networks have largely been conceived of and managed as primarily passive entertainment pipes. The needs of the digital worker or cottage artisan have been more or less successfully ignored. But a bona fide and easily defined local productivity need, such as home-to-clinic, home-to-hospital, or primary care office-to-specialist telehealth, can't be dismissed so easily.
Of course, for fairly basic asynchronous activities such as transmission of remote monitoring device data, the current state of the nation's broadband networks are likely to suffice for some time. But for synchronous video exams and consultations, and uploads of digital images, 3 Mbps is far from adequate. The Benton Foundation, a non-profit digital communications analysis and advocacy organization, quotes veteran telecommunications attorneys Jim Baller and Casey Lide:
"Under the FCC's former definition of "broadband" (200 Kbps), it would take nearly a full day to download a 10 minute diagnostic video clip. At current DSL speeds, it would take almost three hours. Moreover, because DSL and Cable Modem Service are typically asymmetric - i.e., upload speeds are much slower than download speeds - it would take much longer than three hours for the patient or his local doctor or health care facility with only DSL or Cable Modem Service to upload the images to forward them to the reviewing health care facility. With a symmetric 100 Mbps broadband connection, it would only take three minutes to transmit the video clip."
Is it likely we'll see ubiquitous 100 Mbps speeds anytime soon? No. But it would indeed be a delicious irony if healthcare siloed healthcare, lagging healthcare, interop-challenged healthcare was the point of the arrow that finally got us out of the download doldrums.
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