Thanks to NC Broadband Matters and Fiona Morgan for sharing this story that describes one family's need for telehealth applications and how changes in North Carolina state law could help boost infrastructure investment. With better connectivity, especially in rural areas, people who have an urgent need for telehealth and related applications, or who live far away from healthcare professionals, can access specialized care only available in urban areas.

Fiona's article originally ran July 24, 2019, on NC Hearts Gigabit's Our Stories.

A Lifeline to Heath: Why Broadband Matters for Telemedicine

by Fiona Morgan

When Daphne Sykes was 21, an accident nearly severed her spine and left her paralyzed from the neck down. At the time, she was a rising senior at UNC-Charlotte getting ready to start a career. During the medical odyssey that followed, she and her family persevered through rehab and occupational therapy, adjusting their routines and their home. Today, almost four years later, she’s a college graduate working remotely as an accountant from her family’s home in rural Cabarrus County, thanks in no small measure to high-speed Internet access.

“She’s been positive throughout this whole situation,” her mother, Lisa Sykes, said. “She’s very energetic. She’s got a dry sense of humor. Her mind is very, very clear. She’s strong in her faith, and very determined.”

The Internet is vital to Daphne’s quality of life. It allows her to do everything from operating the lights in her room to communicating with clients. “Broadband really opens up opportunities to her,” Lisa said.

For Daphne, being able to stay in constant communication with her doctor via email is essential. Like many people with spinal cord injuries, Daphne experiences neuropathic pain, often in the form of pins and needles on her feet, as well as muscle spasms. For these and other ongoing health issues, she takes a variety of medications that need frequent adjustment. A mild cold, or even a thunderstorm, can throw her health off balance. 

The results of a study are in and its authors recommend Stark County invest in a regional middle mile fiber-optic network, establish a broadband authority, and take other significant steps to keep the county from falling behind in today’s economy.

The Fourth Utility

The county has relied heavily on manufacturing and retail in the past but as those opportunities dry up, young people are moving away and the future is in jeopardy. Healthcare is another strong industry in the region, but access to high-quality connections is now a must-have for hospitals and clinics. Elected officials also recognize that diversifying the local economy to lure companies that offer higher paying positions will bring new blood to Stark County.

In order to attract new commerce to Stark County, Ohio, they formed a Broadband Task Team (SCBBTT) in the fall of 2014. They have adhered to the philosophy that connectivity is a “fourth utility” and should be treated like electricity, water, gas, or sewer systems. In May, the SCBBTT hired a consultant to perform a feasibility study; the firm presented its findings and recommendations on October 12th.

Consultants Offer Results, Recommendations

Consultants analyzed the amount of fiber in the county and reviewed the state of connectivity for businesses and residents and found both lacking.

Incumbents include local provider MCTV, which offers cable TV, Internet access, and phone services over its coaxial fiber network. Charter Communications, which recently acquired Time Warner Cable assets in the area, and AT&T offer cable and DSL but the feasibility revealed that there is very little fiber connectivity for residents or businesses.

They recommend that the county employ a six-pronged approach:

The Coalition for Local Internet Choice North Carolina chapter (CLIC-NC) and the Community Broadband Networks Team here at the Institute for Local Self-Reliance (ILSR) have teamed up to create a new fact sheet: Fast, Affordable, Modern Broadband: Critical for Rural North Carolina.

This fact sheet emphasizes the deepening divide between urban and rural connectivity. The fact sheet can help explain why people who live in the country need services better than DSL or dial-up. This tool helps visualize the bleak situation in rural North Carolina and offers links to resources.

Rural North Carolina is one of the most beautiful places in the country but also one of the most poorly served by big Internet access providers. The gap between urban and rural connectivity is growing wider as large corporate providers choose to concentrate their investments on a small number of urban areas, even though 80 percent of North Carolina's counties are rural.

To add insult to injury, North Carolina is one of the remaining states with barriers on the books that effectively prohibit local communities from making decisioins about fiber infrastructure investment. CLIC-NC and ILSR encourage you to use the fact sheet to help others understand the critical need for local authority.

Download it here, share it, pass it on.

Learn more about the situation in rural North Carolina from Catharine Rice, who spoke with Chris in episode 184 of the Community Broadband Bits podcast.

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:

Communities all over Colorado have voted to reclaim local authority during the past year. Even though elected officials in Fort Collins are exploring the municipal network option, the City Council has yet to present the question to voters. Editors at the local news outlet, the Coloradan, recently expressed their support for a municipal broadband network, urging community leaders to let voters decide.

The Editorial Board focuses on the benefits Fort collins can expect from increased economic development, telemedicine capabilities, and relieved congestion from telecommuting. They see Internet access as one of the essential services cities provide such as water and electricity. The Editorial Board notes that city leaders have already budgeted $300,000 to create a strategic plan that includes community broadband.

The Board acknowledges that there are many unanswered questions - funding, cost, motivation for a deployment. Yes, questions need to be answered along the way, but it is time to move forward:

One hurdle is a 2005 state law that bans municipalities from starting their own telecommunications service, however, either a local vote or a federal waiver could override the law.

The time is now to sidestep the ban and approve municipal broadband.

Westminster began its FTTP pilot project last summer and interest is high. Brett Lake from the Carroll County Times recently reported the project is growing. According to the story, the Mayor and Common Council voted in late November to spend city capital projects reserve funds to expand the pilot. 

During the engineering phase of the project, officials identified several opportunities to expand the footprint at nominal construction expense. The additional reach will include an industrial park and a residential neighborhood adjacent to Carroll Lutheran Village, one of the original sites. 

The Village is a continuing care facility of single- and multi-family dwellings. Project leaders hope to learn to serve both with the pilot project. Residents also receive healthcare services so the fiber network will facilitate onsite telehealth.

The city will also install a ring for redundancy within the Air Business Center to connect potential business customers. The business center is adjacent to the industrial park that will now be included in the pilot project.

Each location is near the Carroll County Public Network (CCPN). Westminster will take advantage of the proximity and will tap into the CCPN fiber to reduce costs. The entire pilot project is estimated at approximately $650,000.

Gary Davis, CIO of the Carroll County Public Schools and Chairman of the CCPN, spoke with Chris in Episode #43 of the Community Broadband Bits podcast. The network serves government, schools, and libraries across the county.

Near the center of Florida sits Lakeland, the largest city between Orlando and Tampa with 98,000 residents. The area boasts 38 lakes, citrus crops, and a growing healthcare industry. Lakeland also owns a fiber optic network serving education, business, and government. To learn more, we spoke with Paul Meyer, Lakeland Electric City of Lakeland Fiber Optics Supervisor.

The city's municipal electric company, Lakeland Electric, began generating and providing electricity to customers in its service territory in 1904. In the mid 1990s, the utility began replacing older copper connections between substations with fiber-optic cable. Soon after, the Polk County School District asked Lakeland Electric to connect school facilities via the fiber network for video transmissions. By 1997, almost 50 school facilities were connected to each other via using dark fiber provided by Lakeland Electric. In 1994, the District paid $219,582 $84,737 to the utility to design, construct, and install equipment for video connections in four schools. The school received an indefeasible right of use for two fibers for twenty years. over which Verizon delivers data and voice services to the School District on its own lines.

Meyer noted that the fiber project likely cost more than the school paid but the installation gave them the opportunity to expand the network. Further expansion connected the police department, libraries, and water facilities. Over time, the electric utility has incrementally expanded to every building engaged in city business. The network is aerial, using the utility's own poles to mount the fiber.

This is a good news/bad news story. The good news is, cable companies are starting to challenge telco dominance in health care communications. According to Bloomberg, they are “ramping up sales staffs to sell broadband access and related services to regional hospitals and doctors’ offices, trying to squeeze more money out of a network they used to use mainly for carrying TV signals.”

The bad news, of course, is that as we transition to digitized medical records, our medical system will be increasingly dependent on the cable/phone duopoly. All companies cited in the article anticipate substantial revenue growth from the health care sector in coming years. Unfortunately, increased revenues to the telecommunications providers means any efficiencies are unlikely to translate into lower health care costs.

Compare this to OneCommunity’s HealthNet, which is driving down costs for health facilities across Northern Ohio by providing affordable access to their gigabit network.

OneCommunity is a non-profit entity that owns and operates its own fiber infrastructure and also promotes interconnection among public and private networks in the region. Its own network is carrier neutral, meaning any service provider can lease access. It connects more than 1,500 entities in 22 counties, including some 65 hospitals. As we've written here, OneCommunity has created enormous cost savings by allowing health care entities to communicate directly with one another, avoiding Internet transport fees.