Showing posts with label mobile wireless. Show all posts
Showing posts with label mobile wireless. Show all posts

Sunday, September 30, 2018

Why is Verizon chasing 4G speed records with 5G only days away?

Why is Verizon chasing 4G speed records with 5G only days away?: After nearly a year of hype, actual 5G service is now only days away. Verizon is launching commercial offerings in four cities next week — but the same carrier is touting an eleventh-hour breakthrough in 4G. Working with Qualcomm and Nokia in a live New York commercial environment, Verizon achieved a peak data speed of 1.45Gbps using LTE Advanced technology.

To put that in some perspective, Verizon’s 5G service is promising customers peak data speeds of 1Gbps — 10 to 100 times faster than typical cellular speeds today — with more typical performance in the 300Mbps range. So when Verizon says that (certain) 4G phones might outperform its 5G network, by a factor of nearly 50 percent, that’s a sure-fire recipe for customer confusion.
Adding to the confusion is the blurring between mobile and fixed service given Verizon's limited test market introduction of 5G fixed premise service. This is where mass marketing fueled expectations collide with reality since this service is naturally very limited to areas with sufficient existing fiber infrastructure and free of terrain and foliage obstructions that block 5G signals. But consumers naturally think it's available to them because a large mobile carrier is deploying it and may already be Verizon Wireless customers. Some have even jumped to the conclusion that it has obsoleted fiber to the premise technology.

Monday, July 24, 2017

AT&T's 4G LTE premise service bolt on could fall short of bandwidth demand

AT&T plans to use cell towers to bring internet access to thousands in rural South Carolina | Business | postandcourier.com: AT&T is planning to use cell towers across South Carolina to bring high-speed broadband to rural areas where internet access is slow to nonexistent. The telecom giant says it's in the process of installing antennas capable of connecting thousands of people in sparsely populated corners of the state. (Emphasis added) Roughly 12,000 homes and businesses will have access to the new service by the end of the year. The work covers some 20 counties in South Carolina under a Federal Communications Commission initiative to boost access in underserved areas. Company spokesman Daniel Hayes declined to say which areas would get service.
The problem is those thousands of people will need a lot of cells backhauled with fiber as bandwidth demand continues its inexorable march upward. Since this technology -- essentially a bolt on to existing 4G LTE mobile network -- is being deployed as a lower cost alternative to fiber to the premise, deploying lots of tower equipment and fiber backhaul would work against the CAPex cost saving objective.

The likely upshot is there will be too many household competing for too little shared bandwidth, particularly in peak evening times when video entertainment streaming and remote learning is done. For example, there have been reports within the past week that Verizon Wireless has throttled video streaming to reduce bandwidth demand.

Sunday, June 18, 2017

The incredibly misinformed "experts"

Lawmakers itching to advance high-speed Internet funding: Last month, the agency issued a notice of proposed rulemaking seeking comment on actions to remove regulatory barriers to infrastructure investment at all levels of government and to better enable broadband providers to build, maintain and upgrade their networks. "This is the kind of thing that is going to get more broadband into the hands of consumers," Joe Kane, a tech policy associate with the R Street Institute, told the Washington Examiner. "It's not a sexy political battle, but it's getting to the [question of] why is your computer really slow? A better example is people who don't currently have broadband. It's people in rural areas where it hasn't been profitable to build out there. Now that we have 5G on the horizon, it'll be more possible to reach those areas."
This except illustrates how misinformed even the experts are when it comes to modernizing  America’s telecommunications infrastructure. First of all, the U.S. Federal Communications Commission is focusing on the wrong issue. It isn’t regulatory barriers that inhibit investment in modern fiber telecommunications infrastructure that serves all premises. The main obstacle is the continued misguided reliance on vertically integrated, investor owned legacy telephone and cable companies to build it. Their business models are incompatible since they require a rapid return on investment. Infrastructure investment by comparison requires billions in patient capital they simply don’t have or cannot raise.

Second, 5G mobile wireless service doesn’t even exist yet. When it does, the same economic constraints that prevent the telcos and cablecos from connecting customer premises with fiber will be at work because all those 5G cell sites will require a lot of fiber to be built to serve them. Doug Dawson explains at his POTS and PANS blog.



Monday, May 15, 2017

FCC Chair Pai shows apparent lack of knowledge on wireless Internet

Pai: Wired, Wireless Appear Very Competitive To Him | Multichannel: At an American Enterprise Institute speech recapping his first 100 days, Pai was asked about that relative competitiveness by host and AEI visiting scholar Jeffrey Eisenach, who was a member of the Trump FCC transition team. Eisenach asked whether Pai thought that wireless is now a substitute for wireline. Pai said, for him, at least, "they are very competitive offerings." The "for him" is because the chairman is always careful to separate his views from what the FCC as a whole might conclude based on the fact record before it. But he suggested that fact record could be a strong one. Pai said that as 4g LTE and 5G networks get rolled out, and the next generation of Wi-Fi is rolled out, " I think we are increasingly going to see that wireless is not this 'imperfect substitute' for wired connections. "It is going to be the dominant means, the preferable means, by which people access the Internet."
This needs to be placed in the proper context. Currently, wireless networks are primarily intended to serve mobile users as a complement to premise service -- and not a substitute since even nominally "unlimited" hotspot plans come with quite restrictive bandwidth useage limitations. In addition, most industry experts don't see even the next generation of mobile wireless, 5G, being able to replace fiber premise service when it's expected to be rolled out in 2020. Assuming Pai is quoted accurately, one might hope that an FCC chair would demonstrate a greater depth of knowledge and bring a more nuanced perspective to this topic.

Friday, January 06, 2017

As usual, AT&T decades late & dollar short, betting heavily on the come

Meanwhile, in terms of its fixed line activities AT&T confirms it is now marketing a 1Gbps connection to nearly four million locations across 46 metropolitan areas nationwide, including more than 650,000 apartments and condominium units. By mid-2019 the telco plans to reach at least 12.5 million locations across 67 metro areas with its fibre service. In addition, AT&T is conducting technology trials over fixed wireless point-to-point mmWave and G.fast technologies with a view to delivering greater speeds and efficiencies within its copper and fibre networks. Finally, the telco expects to launch a new fixed wireless internet (FWI) service in mid-2017 in areas where it has accepted Federal Communication Commission (FCC) Connect America Fund Phase II (CAF II) support. The operator expects to reach more than 400,000 locations by the end of 2017 across 18 states, most of which will get internet access for the first time. By the end of 2020 AT&T plans to reach 1.1 million locations in those 18 states.
It's mind boggling to consider the boldfaced sentence above that notes premises in AT&T service territory will get their first Internet access between 2017 and 2020. Those premises will be served by a bolt on adjunct to its mobile wireless infrastructure that will be obsolete even before its deployed and highly likely bog down during peak periods as its shared bandwidth becomes saturated with heavy, multi-premise demand. Had AT&T's predecessor SBC Communications and other regional bell operating companies stuck to their early 1990s plans to replace their copper networks with fiber to customer premises, they would have likely completed that task by 2008 to 2010. They didn't. Consequently, the quality of America's telecommunications infrastructure has suffered greatly, deficient for the needs of today and tomorrow.

This item from TeleGeography (excerpted above) also outlines AT&T's residential strategy that heavily relies on its mobile wireless plant as a successor to its VDSL-based U-Verse hybrid fiber/copper service that suffers from severe bandwidth constraints due to the aging copper cable plant service customer premises. The wireless link to customer premises is apparently going to replace the twisted pair copper. It remains to be seen whether AT&T can overcome the technological challenge of being able to deliver adequate bandwidth over the wireless link to customer premises. And equally critical, the economic challenge of having to invest considerable capital in fiber to backhaul all of the necessary radios that would essentially require nearly every premise to have one, similar to step down transformers for residential electric service. 

Wednesday, October 05, 2016

AT&T’s bifurcated, speculative strategy on residential telecom service

AT&T has adopted a bifurcated and highly speculative future strategy for its residential premise telecommunications market segment that treats a small portion of it like a specialized business market for its fiber to the premise (FTTP) service while serving other residential customers with a mix of wireless technologies.

AT&T Fiber is primarily aimed at business premises and multi-family buildings and not single family homes. The company is phasing out its legacy U-Verse service that blends fiber to neighborhood distribution equipment with copper from the era of Plain Old Telephone Service (POTS) – metallic infrastructure it is anxious to retire as quickly as possible to avoid the cost of maintaining it. In its place AT&T is relying on proven and unproven radio-based technologies.

In some high cost areas of its U.S. service territory, AT&T recently announced it would construct infrastructure designed to deliver fixed residential premise service as part of upgrading its mobile wireless service to 4G LTE technology. However, that infrastructure will be obsolete the day it’s installed, not even close to approaching what the U.S. Federal Communications Commission considers service capable of supporting high-quality voice, data, graphics and video. It’s essentially a bolt on afterthought to a 4G LTE mobile wireless service upgrade that will likely bog down during peak periods as its shared bandwidth becomes saturated with heavy, multi-premise demand.

As for the unproven radio-based technology that’s still in the development phase, AT&T recently announced its experimental “Project AirGig” technology. It will utilize antennas mounted atop utility poles to transmit millimeter wave signals from pole to pole. It taps into those signals to feed premise service based on 4G (or more optimally, AT&T’s still under development 5G wireless technology.) The service will apparently be similar to electrical power distribution architecture where current from high voltage transmission lines on the tops of poles is stepped down by a transformer before it flows into a home. This service in theory would be capable of meeting the FCC’s minimum service standard. But at this point, it’s largely speculative and leaves much of AT&T’s residential market segment with no clear and certain future path as its legacy copper cable POTS plant rots on the poles.

Friday, July 15, 2016

Obama administration plays up mobile wireless, ignores 34 million Americans lacking modern landline premise telecom service

As the Obama administration winds down, it is declaring a hollow victory on telecommunications infrastructure, playing up mobile wireless technology while ignoring the plight of some 34 million Americans whose homes and small business that lack service capable of delivering high-quality voice, data, graphics and video, according to figures released by the U.S. Federal Communications Commission earlier this year.

Mobile wireless is also being termed by incumbent telephone companies as a technological transition from non-IP based services that supported legacy telephone, cable TV and early mobile wireless services to Internet protocol-based services. Problem is many of those aforementioned 34 million Americans are being left out of the transition since landline infrastructure isn't being modernized and built out to serve them. And as many observers have pointed out including here, mobile wireless service alone cannot meet the needs of homes and small businesses due to technological constraints and high cost.

Tuesday, May 10, 2016

Motley Fool item on 5G as premise service overlooks #FTTP

AT&T and Verizon's 5G Ambitions Are Cable's Worst Nightmare -- The Motley Fool: When it comes to picking a cable Internet provider, you usually have one (maybe two, if you're lucky) options. Time Warner Cable (NYSE:TWC) and Comcast (NASDAQ:CMCSA) provide Internet to about 71% of new Internet subscribers in America right now. That percentage is expected to stay about the same if Charter Communications' purchase of Time Warner Cable goes through.

The near-duopoly of cable providers in many regions of the country is a long-standing problem -- and wireless providers may have found a solution. You may already know AT&T (NYSE:T) and Verizon Communications (NYSE:VZ) are in the process of testing 5G networks, which will bring much faster and reliable connections than even 4G LTE. But what you may not know is that 5G could also be used as an ultra-fast wireless connection for home broadband, too.

How 5G home broadband works.
Cellular connections work by sending out long-range signals from very large towers, but 5G home broadband would work a bit differently. AT&T and Verizon are testing out what's called "fixed wireless" in which a home wireless router would receive a signal from small cellular boxes (called small cells) placed much closer to your home than large towers.

Missing from this Motley Fool story is the cost/benefit tradeoff discussion comparing 5G to fiber to the premise (FTTP). Wireless does indeed have greater throughput capacity when the signal doesn't have to travel far such as in-building Wi-Fi. But it will take a lot of fiber installed relatively close to customer premises to support those small cell sites. So close, in fact, that it raises the question as to whether 5G makes sense as a premise telecom service delivery technology considering the small additional cost of bridging the short distance between small cell sites and customer premises with a direct FTTP connection. A connection that is far more future proof, less subject to interference and obstacles such as hills and foliage and offers far greater carrying capacity.

Friday, January 08, 2016

New year, same FCC finding: Advanced telecom infrastructure not being deployed in a reasonable and timely fashion

As it has since 2010, the U.S. Federal Communications Commission is expected to report this month that advanced telecommunications infrastructure is not being deployed in a reasonable and timely fashion. Consequently, 34 million Americans still lack access to landline premise service with 39 percent of the nation's rural population left without service, according to a draft progress report required under Section 706 of the Communications Act issued this week.

On the heels of a Pew Research Center study finding that premise service connections have leveled off as more Americans exclusively use mobile wireless devices for Internet access, the draft FCC report notes these consumers tend to perform a more limited range of tasks and are significantly more likely to incur additional usage fees or forgo use of the Internet.

Thursday, January 07, 2016

AT&T exec: Mobile wireless primary driver of fiber deployment (and John Donovan's inapt cite of Moore's Law)

Donovan: AT&T Beating Moore's Law | Light Reading: Part of achieving those capex gains while continuing to meet rising demand for bandwidth is AT&T's integrated planning. While its Project VIP local fiber deployment initiative has wound down, the company is still able to push fiber more deeply into some areas, based on the need for business services or backhaul for cell towers and small cells, Donovan said.

"We have a really good cost curve on incremental costs for wireless," he said. "We are still putting fiber out where it is economic -- that is a big part of our program."

Yet another project to nominally push fiber to premises -- like Project Pronto and  Project Lightspeed before it-- is going away as AT&T like other big telcos shifts its focus away from residential and small business premise service to the mobile segment.

Donovan's invocation of Moore's Law unfortunately perpetuates the incorrect analogy of telecommunications service as a consumptive utility like electric power or natural gas. In the world of telecommunications, Moore's Law more properly applies to the growth in consumer bandwidth demand as I blogged in 2010. Additionally, Moore's Law applied to the total microprocessor market unlike the segmented markets employed by legacy telephone companies like AT&T.

Tuesday, December 01, 2015

Transition from copper to fiber plant? Show me the fiber.

From a Communications Workers of America (CWA) Nov. 29, 2015 blog post:
The Communications Workers of America (CWA) filed reply comments at the Federal Communications Commission (FCC) in support of an FCC proposal to adopt clear criteria to evaluate a telecom carrier’s request to discontinue, reduce, or impair legacy service. As communications infrastructure changes from copper to fiber, the fundamental goals of communications policy remain the same: universal service, consumer protection, public safety and national security, and competition.
Note the emphasized text on the transition from copper to fiber. Reading further leads to some major cognitive dissonance that suggests telcos aren't in fact transitioning from copper to fiber but instead retiring their landline outside plant and sending residential and small business customers to satellite and their mobile wireless offerings:
CWA urged the FCC to add an additional criteria: affordability. If an alternative service is more expensive -- such as wireless with data caps or satellite service for Internet access -- then it is not an adequate substitute to legacy wireline service.

Thursday, November 12, 2015

Mobile wireless service won't solve America's telecommunications infrastructure crisis

Congress Seeks to Bolster Nation’s Broadband: (TNS) -- A draft bill making the rounds among Senate lawmakers would require selling even more airwaves than initially agreed to in the recent budget deal.

The language is part of a proposal that would move forward several bipartisan efforts aimed at boosting high-speed Internet access nationwide. The wide-ranging discussion draft bill in the Senate Commerce, Science and Transportation Committee comes after a series of hearings in recent weeks by the committee and its House counterpart where Republicans and Democrats have called for auctioning government-held airwaves to the private sector to increase the amount of wireless spectrum available to carry voice and data over the air. (Emphasis added)

"Boosting high-speed Internet access nationwide" isn't solely about mobile wireless as this story suggests. The biggest component of the United States' Internet access problem is landline-delivered premise -- and not mobile -- service. According to a U.S Federal Communications Commission estimate issued earlier this year, approximately 55 million Americans – about 17 percent of the population -- live in areas unserved for basic Internet service capable of supporting high-quality voice, data, graphics and video. Meeting this need requires fiber to the premise infrastructure. It can't be served by mobile wireless services alone because they can't offer adequate bandwidth to meet premise needs given the multiple connected devices used in the home.

Wednesday, November 11, 2015

A Last-Ditch Attempt to Start a 5th U.S. Telecom

A Last-Ditch Attempt to Start a 5th U.S. Telecom: Social Capital’s Chamath Palihapitiya, a former Facebook executive, said on Tuesday that he intends to build an American mobile carrier called Rama. It’s good timing—the window for building a fifth major American telecom is closing, and soon, it may not be possible anymore.

* * *

Even if Rama ends up winning the spectrum it needs, it faces an uphill
battle. First, the company will have to start the slow and expensive
process of actually building the towers and infrastructure that make up a
wireless network. Palihapitiya said he wants to use “microcells,” or
tiny cell towers installed on people’s homes, to help build the network
quickly and provide better coverage. (Emphasis added)

The apparent strategy here is to use telco and cableco residential landline to backhaul the microcells. That of course will generate strong resistance from the large incumbent telcos and cablecos that also play or want to play in the mobile wireless space and prompt them to put restrictions in their residential service contracts disallowing the use of premise Internet service to support commercial mobile networks.

Friday, October 30, 2015

Blair Levin's "broadband competition" fantasy

Achieving Bandwidth Abundance: The Three Policy Levers for Intensifying Broadband Competition | ISOC-DC: The trial and many errors of my own work have led me to believe in the following bottom line: that the highest priority for government broadband competition policy ought to be to lower input costs for adjacent market competition and network upgrades. Today I will make the case for that bottom line and illustrate where I think the greatest opportunity is; to create a virtuous cycle of upgraded mobile stimulating low-end broadband to upgrade, which in turn causes an upgrade of high-end broadband which, by using its assets to enter mobile, accelerates the need for mobile to accelerate its upgrade further.

Blair Levin, a Brookings Institution fellow who drafted the U.S. Federal Communications Commission's National Broadband Plan issued in 2010, somehow believes boosting mobile wireless "competition" to offer greater bandwidth will generate synergistic "competition" among landline premise Internet service providers and result in "bandwidth abundance." 

It's utter hogwash for the simple fact that telecommunications infrastructure -- regardless of whether it supports mobile or premise service -- is not a competitive market. Never has been and never will be due to high cost barriers to entry and uncertain return on investment as a mathematical expression in Levin's presentation illustrates. 

Levin's fantasy scenario would have us believe that if Verizon deploys next generation 5G mobile service, that would somehow spur Comcast or AT&T, for example, to upgrade and build out fiber to the premise (FTTP) infrastructure in areas where Verizon has rolled out 5G mobile. It's wishful economic sophistry. Levin offers no explanation as to how or why that would occur.

Friday, August 07, 2015

FCC inquiry could set stage to further reduce pressure on telcos, cablecos to deploy last mile infrastructure

Now that the U.S. Federal Communications Commission appears to be whiffing on enforcing Title II’s universal service and anti-redlining provisions relative to Internet service despite deeming Internet service a common carrier utility in a rulemaking earlier this year, it appears to be setting the stage to give big incumbent telephone and cable companies another potential pass on modernizing and building out their last mile infrastructures.

The FCC signaled that possible gambit this week in opening its annual review as required by Section 706 of the Telecommunications Act of 1996 to determine whether advanced telecommunications capability is being deployed to all Americans in a reasonable and timely manner.

In previous reviews, the FCC examined advanced telecom infrastructure providing both landline premise as well as mobile wireless and premise satellite service but opted to include only premise landline service in its determination, citing “significant concerns about the quality and reliability of the mobile and satellite service data” as well as factors including latency and usage allowances.

The 2015 review determined infrastructure deployment remained untimely as in previous reviews dating back nearly two decades and that 55 million Americans – 17 percent of the population – lack access to advanced telecommunications services capable of supporting high-quality voice, data, graphics and video.

For its next annual review, the FCC announced an inquiry this week seeking comment on whether mobile wireless and satellite should be included:

While fixed terrestrial broadband service can have advantages for high-capacity home use, mobile broadband has become increasingly important for many uses, including connecting on social media, navigating during travel, communicating with family and friends, receiving timely news updates, and more. In the event mobile broadband is added to the assessment, the FCC is seeking comment on what speed of service should serve as the benchmark for assessing availability. The FCC is also proposing to consider the availability of fixed satellite broadband in its annual assessment of fixed broadband availability.

Such a move could also pave the way for creating a benchmark lower than the new speed standard of 25 Mbps down and 3 Mbps up established in the 2015 Section 706 review since this level of service is not offered by mobile wireless and satellite providers. That would make it easier for the FCC to declare advanced telecom infrastructure is in fact being timely deployed. Doing so would effectively sanction the deplorable status quo that has existed for many years where about one in five customer premises remain unable to obtain premise landline Internet service.

Thursday, July 30, 2015

Doug Dawson explains why telco wireless can't substitute for FTTP

What is 5G? | POTs and PANs: What all of this means is that a 5G network is going to require a lot more cell sites packed closer together than today’s network. That has a lot of implications. First, it means a lot more investment in towers or in mini-cell sites of some type. But it also means a lot more fiber to feed the new cell sites. And those two factors together mean that any 5G solution is likely to be an urban solution only, or a suburban solution only for those places where a lot of users are packed tightly together. No wireless company is going to invest in a lot more 5G towers and fiber to cover suburban housing sprawl and certainly nobody will invest in the technology in rural areas.

We already have a cellular wireless divide today with urban areas getting pretty decent 4G and rural areas with 3G and even some 2G. Expect that gulf to become greater as high-bandwidth technologies come into play. This is the big catch-22 of wireless. Rural jurisdictions have always been told to wait a while and not clamor for fiber because there will eventually be a great wireless solution for them. But nobody is going to invest in rural 5G any more than they have invested in rural fiber. So even if 5G is made to work, it’s not going to bring a wireless solution to anywhere outside of cities.

Doug Dawson provides a good explanation of why the economics and technology of telco wireless service -- including the next generation 5G service -- can't provide an economical solution compared to fiber to premise. Aside from spectrum providing inadequate bandwidth for growing household demand that only fiber can satisfy, telcos would have to invest in a lot more cell sites to feed the network, which as Dawson explains can't pencil out except in very densely populated areas.

Monday, March 23, 2015

Obama administration continues to ignore US need for ubiquitous FTTP

The Obama administration continues to ignore the need for ubiquitous fiber to the premise infrastructure serving all American homes and small businesses.

The administration instead is pursuing a PR campaign to shift attention to mobile wireless service that can't accommodate growing premise bandwidth demand as well as pointless activities such as "broadband mapping" and measuring "broadband speeds" that will do nothing to construct the FTTP infrastructure the nation should have been putting in place a generation ago.

Thursday, February 05, 2015

No fast or slow lanes for Internet? New rules proposed | The Sacramento Bee

No fast or slow lanes for Internet? New rules proposed | The Sacramento Bee: "Net neutrality" means that whether you're trying to buy a necklace on Etsy, stream the season premiere of Netflix's "House of Cards" or watch a music video on Google's YouTube, your Internet service provider would have to load all of those websites equally quickly.
This is a much less important problem in the United States than inadequate Internet infrastructure that leaves millions of American homes and small businesses to substandard slow dialup, satellite or costly bandwidth rationed mobile wireless connections. The Federal Communications Commission recently reported that Internet infrastructure is not being deployed in a timely manner.

Sunday, June 01, 2014

Why you shouldn’t buy the miracle broadband network Softbank’s Masayoshi Son is selling - Yahoo Finance

Why you shouldn’t buy the miracle broadband network Softbank’s Masayoshi Son is selling - Yahoo Finance

An excellent reality check by GigaOM's Kevin Fitchard on claims by Masayoshi and other wireless space players that wireless can substitute for landline premises Internet service.

The numbers simply don't pencil out in terms of cost and carrying capacity and aren't ever likely to as premises bandwidth demand keeps growing rapidly. Star Trek's 23rd century quantum subspace channel hasn't yet arrived, space fans.

Monday, April 28, 2014

Telehealth provider complains many consumers lack bandwidth to meet newly adopted telehealth guidelines

Model policy designed to guide state medical boards in regulating the delivery of medical services remotely via telemedicine (also referred to as telehealth) has drawn protest over its requirement that doctors and patients cannot rely exclusively on lower bandwidth applications such as texting, email and voice communications and instead must utilize higher bandwidth secure Internet videoconferencing.

“Not everybody has a video device or has access to the bandwidth” to make the standard useful, said Henry DePhillips, chief medical officer of Teladoc in remarks reported by Modern Healthcare. Even for consumers in an urban setting, “over 95 percent of the time, will chose the telephone, even if they have the device and the bandwidth,"DePhillips added.  

The Federation of State Medical Boards Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine defines telemedicine as follows:
“Telemedicine” means the practice of medicine using electronic communications, information technology or other means between a licensee in one location, and a patient in another location with or without an intervening healthcare provider. Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation, or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional, encounter in person between a provider and a patient. 
The bandwidth adequacy concern raised by DePhillips has merit insofar as a sizable segment of American homes are located in areas that lack telecommunications infrastructure able to reliably support videoconferencing, while the pricing models of mobile wireless providers are designed to discourage the use of high bandwidth applications.