Telemedicine: Benefitting Providers & Patients | USTelecom

Telemedicine: Benefitting Providers & Patients | USTelecom

A number of presenters at this week's California Telehealth Network 2015 Summit #TELEHEALTH2015 mentioned deficient telecommunications infrastructure and services as a key impediment to greater adoption of telehealth, particularly in rural areas where it can offer the greatest benefit to patients and providers.

New eBook cites telecommunications infrastructure deficiencies as impediment to location independent knowledge work

My new eBook Last Rush Hour: The Decentralization of Knowledge Work in the Twenty-First Century is out. This book discusses how the proliferation of Information and Communications Technology (ICT) is changing how, when and where knowledge work is done and the implications for individuals, organizations and society.

Telecommunications infrastructure deficiencies are mentioned as a speed bump slowing the momentum of this major socio-economic shift.

California Internet infrastructure subsidy rules erect roadblocks for last mile fiber projects

A notable aspect of California’s eight-year-old program to subsidize the cost of constructing Internet telecommunications infrastructure is the general lack of participation by incumbent telephone and cable companies. In that regard, it has not fulfilled the usual public purpose of subsidy programs designed to help offset the costs of building and operating telecommunications infrastructure in high cost areas such as those used for landline telephone service.

The program, the California Advanced Service Fund (CASF), is administered by the California Public Utilities Commission, which is directed under California Public Utilities Code Section 281(a) to "administer the CASF to encourage deployment of high-quality advanced communications services to all Californians that will promote economic growth, job creation, and the substantial social benefits of advanced information and communications technologies..."

Instead, the CASF has subsidized mostly middle mile fiber and a small number of last mile wireline and wireless projects by non-incumbents. The last mile projects have nearly all been located in remote areas of California not served by the incumbent telephone and cable companies. Proposed projects elsewhere such as the Bright Fiber project in the Sierra Nevada foothills have been subject to lengthy bureaucratic delays under CPUC rules governing CASF eligibility.

The rules parse the state into thousands of discrete “unserved” and “underserved” areas where existing providers don’t sell specified advanced telecommunications services and authorize incumbents to challenge projects that would overbuild them and fall outside of these designated areas. The rules and a federally-funded project by the CPUC to map these areas have served to erect red tape roadblocks that stymie projects proposed by non-incumbents as project proposers, incumbents and consumer advocates argue over the mapped territories and boundaries. These parochial disputes have chewed up enormous amounts of time and resources and delayed construction of much needed telecommunications infrastructure, defeating the public policy intent of Section 281(a).

While California is not among about 20 states that have statutes designed to protect incumbents from overbuilders, the CASF rules have operated to produce a similar result, leaving millions of California residents without robust wireline Internet service options. California innovated much of today’s information and communications technology and is rightly regarded as a leader in the field. However, when it comes to advanced telecommunications infrastructure, the Golden State is a laggard.

Why legacy telcos, cablecos are incorrect in arguing government-built fiber telecom infrastructure is "unfair competition"

The primary public policy argument advanced by the legacy incumbent telephone and cable companies in support of state laws proscribing or prohibiting the public sector from building or subsidizing community owned fiber to the premise (FTTP) Internet telecommunications infrastructure is that doing so represents unfair competition against them.

It’s a fallacious argument because the incumbents and communities aren’t in the same business – a basic prerequisite for market competition.

The incumbents are in the business of packaging and selling discrete bits of Internet bandwidth. They sell it by throughput speed with speed tiered pricing for wired premise service and by volume – the gigabit -- for mobile (and inappropriately for premise) wireless services. The faster the connection and the more bandwidth consumed, the higher the price. Naturally, the incumbents segment their service territories and product offerings to generate the highest possible profit for that bandwidth. After all, they owe it to their shareholders.

State and local governments on the other hand aren’t in the bandwidth business or selling it to generate maximum profit. They are in the infrastructure business – planning, constructing and financing it to support public objectives such as economic development and enhancing the delivery of public services. In the 20th century, they did that by building roads and highways. In the 21st, they do it by building FTTP infrastructure.

Tiered rates for Internet service cannot be justified and demand attention from utility regulators

Homeowners and business operators are familiar with tiered rates in which a premise pays more for using higher amounts of water, electricity or natural gas. These are consumptive utilities that impose greater costs on utilities to provide them in larger quantities, thus justifying higher rates. At the same time, tiered rates encourage conservation of these finite resources by tapping into the economic principle of price elasticity. The principle holds that as price increases, demand declines and vice versa.

Encouraging conservation by making consumers pay more to use more – and hence reducing demand via price elasticity – makes sense in the case of water, for example, in the severe drought being experienced in California and other parts of the western United States. But it doesn’t make sense for America’s latest utility as recently declared by the U.S. Federal Communications Commission: Internet telecommunications service.

Internet service providers inappropriately price the utility as if it were a consumptive, resource-based one like water, electricity or natural gas. For example, this week Frontier Communications announced it is offering fiber-delivered Internet service with speed tiers of 30/30, 50/50, 75/75, 100/100 and 150/150 Mbps in Beaverton, Oregon. The higher the speed, the higher the monthly price.

It makes no sense to slice and dice Internet bandwidth like this on a fiber circuit with huge carrying capacity. Nor can it be rationally argued that providing higher speed tiers to a customer premise imposes higher marginal costs to deliver them and they therefore should be priced above lower speed tiers. This market practice cannot be economically justified. Moreover, it is exploitative of and unfair to consumers and demands attention by telecommunications regulators.

AT&T launches ultrafast Internet service in Cupertino - ContraCostaTimes.com

AT&T launches ultrafast Internet service in Cupertino - ContraCostaTimes.com: It's also unclear just who in Cupertino will be able to receive the GigaPower service. At launch, the service is available at "several thousand" homes in the city, said Terry Stenzel, vice president and general manager of the Northern California and Reno region for AT&T. But Stenzel declined to give an exact number or say what percentage of the 20,000 households in the city or what neighborhoods have access to the service, citing competitive reasons.

"They're unwilling to tell anybody. Not even me," Mayor Sinks said.

Cupertino doesn't have any commitment from AT&T to offer service to all areas of the city or to bring service to government buildings, schools or hospitals, Sinks said.

"They've stopped short of any commitment on that," he said.

Now that the U.S. Federal Communications Commission has adopted rules this month classifying Internet as a universally available common carrier telecommunications service, it's going to be more difficult as time goes on for dominant providers to cherry pick and redline neighborhoods as is being done here.

Open access fiber networks offer way to boost access to Internet services

The United States suffers from costly and disparate Internet access due to a vertically integrated business model based on the old copper telephone network. Under that model, the network infrastructure and the telecommunications services sold over it are provided by a single company such as AT&T or Verizon. It’s the same model used by cable companies, where the network operators that bring the cable to customer premises “own” the customer and bill for separate or bundled services on a monthly subscription basis. Google Fiber also operates under this business model.

That business model is inherently limited because it can expand and upgrade service only to the extent new customers and revenues can be added quickly enough to generate a rapid return on the money invested to build out the infrastructure. That circumstance and the high cost of constructing telecommunications infrastructure naturally make telcos and cable companies very conservative when it comes to expanding their networks.

That risk aversion in turn has brought about widespread market failure. There are potential buyers clamoring for service but the telephone and cable companies decline to provide it. This is essentially where the U.S. has been stuck for the past decade, creating massive frustration for consumers and for state and local governments hoping to improve Internet telecommunications access that has grown increasingly vital for their communities and economies.

Fortunately, there is a way out of the mire with open access fiber networks as Andrew Cohill of Wide Open Networks explains in this article appearing in the March/April issue of Broadband Communities magazine. Highly recommended reading for government officials and consumers.

As health care goes online, Internet infrastructure takes on greater importance

Internet Backup Options Can Be Pricey, Complicated - Data Centers on Top Tech News: Disruptions to Internet service can and do happen for many reasons, ranging from hacker attacks to solar storms. With online access vital for so many services today, such interruptions can be far from merely inconvenient.

Last month's vandalism in Arizona, for example, raised "major implications for telehealth in northern Arizona," according to the Arizona Telecommunications & Information Council. That's a concern for many rural and tribal communities for whom phone and Internet services can be the primary means of accessing health care.

San Antonio’s size proving to be a challenge for Google Fiber - San Antonio Business Journal

San Antonio’s size proving to be a challenge for Google Fiber - San Antonio Business Journal: One of the challenges for Google is developing the infrastructure needed to support a new fiber-optic network, including a system of equipment shelters. That process is complicated because of land mass and topography.

But Google officials insist that the company continues to work with San Antonio officials and expects to have a progress report on the Alamo City’s expansion status before the end of the year.

Reading between the lines, it appears Google Fiber is facing the classic demand muni officials have made of cable providers in franchise negotiations, i.e. that the providers serve all addresses and not just some per Google Fiber's walled garden "fiberhood" infrastructure deployment strategy.

As Google Fiber looks to expand, it will likely increasingly confront this demand and choose to walk away, especially if state public utility commissions back up local governments by enforcing the U.S. Federal Communications Commission's recently adopted rules designating Internet services as common carrier utilities subject to a universal service mandate. That factor along with its limited financial resources to build costly telecommunications infrastructure will significantly limit Google Fiber's U.S. expansion under its current "own the customer" business model.

AT&T hopes to squeeze more milk from the pay TV cow to boost earnings and pay dividends -- not to fund network CAPex

New Services Cloud AT&T’s Bet on Pay TV - WSJ: AT&T Inc. knew it was buying a melting ice cube when it agreed to acquire satellite-TV company DirecTV last year for $49 billion. But recent moves by HBO, Apple Inc. and the National Football League have turned the temperature up a few degrees.

A wave of new TV services delivered over the Internet allow Americans to get prime programming like the hit HBO series “Game of Thrones” and ESPN sports without paying a big cable or satellite bill. That, in theory, means fewer customers for bundles of TV channels like those sold by DirecTV. And unlike cable companies, DirecTV doesn’t have a significant broadband business to fall back on.

AT&T is aware of the risks. Chief Strategy Officer John Stankey says the telecom giant figured when it did the deal that demand for traditional bundles of TV channels probably had peaked. But AT&T is betting the decline will be slower than many people think—a gradual 34-degree melt, as opposed to a 75-degree one— and that it will be able to milk the cash produced by the declining satellite business in the meantime to fund upgrades in its networks. (Emphasis added)

It's an unlikely bet since given AT&T's business structure and strategy. Milking the pay TV cow boosts earnings and pays fat dividends, not CAPex.

FCC Commissioner Pai should resign, get new job as lobbyist or run for Congress

This report courtesy of ExtremeTech:
 

FCC Commissioner Ajit Pai spoke to the House of Representatives on Tuesday, and took the unusual step of requesting that Congress forbid the FCC from using any appropriated funds to enforce its net neutrality ruling.

Pai's entitled to his opinion, of course. But for a sitting Federal Communications Commission member to go before Congress asking it to restrict its funding doesn't pass the smell test of proper protocol respecting the constitutional separation of powers. If Pai wants to appropriate, he should resign his FCC post and run for Congress. Or become a lobbyist. 

UTOPIA holdout cities should adopt broader view of economic benefit of UTOPIA-Macquarie PPP

Orem, Utah and four other cities that have opted out of a public-private partnership between the Utah Telecommunication Open Infrastructure Agency (UTOPIA) and Macquarie Capital Group are now grappling with a fundamental question as to how to finance the future operation of fiber to the premise (FTTP) telecommunications infrastructure to serve their residents. The question: support the partnership’s public works approach to the increasingly essential infrastructure or default to legacy incumbent telephone and cable companies and the poor value and customer service and disparate access they typically offer as monopoly providers.

Six of the 11 cities comprising UTOPIA agreed in concept in 2014 to assess a parcel utility fee to help offset the cost and mitigate the business risk associated the pure subscription-based model used by incumbent providers. They mitigate their business risk by cherry picking neighborhoods believed to have the greatest profit potential for their proprietary network investments while redlining those that don’t.

The utility parcel fee is a key sticking point in negotiations between UTOPIA and the five hold out cities including Orem. A Daily Herald dispatch cites from a memorandum to the Orem mayor and council from Orem City Manager Jamie Davidson:

"There is a concern that Orem is unpredictable and not easy to work with," Davidson said. "It's concerning to me to see new options entering the market [UTOPIA] with a stranded investment for the future."

“However, bottom line, the proposal remains a utility fee-based model,” Davidson said. “If, as a council, you cannot wrap your arms around the assessment of a monthly utility fee to all customers (with potentially a few exceptions, for example, the indigent), nothing else matters.”

Davidson’s right. The parcel fee is essential to making the UTOPIA partnership with Macquarie pencil out by mitigating the business risk of relying solely on customer subscription revenues. UTOPIA operates an open access fiber network, enabling competition among ISPs that want to offer customer premises services delivered over the network. In that regard, the UTOPIA network is like a road or other public works project that benefits and enhances the value of the properties it passes. The UTOPIA cities benefit because these properties can support higher levels of economic activity as well as boosting their market value and, by extension, their ad valorem property tax revenue potential to fund other municipal services.

New Homeowner Has To Sell House Because Of Comcast’s Incompetence, Lack Of Competition – Consumerist

New Homeowner Has To Sell House Because Of Comcast’s Incompetence, Lack Of Competition – Consumerist

A sad tale of a consumer jerked around by incumbents and misled by the U.S. government's "broadband map" -- a major and useless component of the Federal Communications Commission's 2010 "National Broadband Plan."

And the consumer might find it hard to sell his home since not having an Internet connection is increasingly becoming like living off the grid.

Let's hope the FCC's recent policy deeming Internet as a common carrier telecommunications service requiring providers to universally serve all premises can help avoid these kinds of unfortunate circumstances that leave consumers high and dry.

Opinion: Internet infrastructure can't be built in a reasonable time frame with limited, incremental funding

Want to boost rural tourism in Maine? Raise Internet speeds — Opinion — Bangor Daily News — BDN Maine: The catch is that corporate providers, like Time Warner Cable and FairPoint Communications, see no profit in extending fiber optics to remote, sparsely populated areas. So the state must be involved, and several remedies are being explored at the State House. Most of these approaches are “incrementalist”; that is, focused on giving slightly more funding to the ConnectME Authority. One proposal would authorize ConnectME to provide more grants so additional communities can plan for extending fiber-optic networks, creating wireless nodes and boosting connection speeds. Other bills propose small bonds to boost ConnectME’s funding.

Incrementalism, however, has fundamental limitations: Few rural communities are prepared to compete for limited ConnectME funds, and few low-density, low-income communities can afford broadband investment on their own. With incrementalism, it will take years, perhaps decades, to connect all of Maine.

Some progress is better than none, but ultimately rural Maine needs a “big push,” analogous to the New Deal’s Rural Electrification program that transformed life in rural America. The big push strategy’s basic premise is that broadband is critical for rural economic competitiveness and also a public good to which all should have access. Rural electrification relied on community-level planning, but it was also backed by massive public investment.

The author of this op-ed nails it. Internet infrastructure like any infrastructure is costly and can't be put in place in a reasonable time frame with limited, incremental funding. The states can't do it alone. The United States needs a national Internet initiative on the scale that built today's highway and electrical distribution infrastructures.

The medium is the message: Google Fiber is primarily an advertising platform

Lest anyone forget that notwithstanding Google's construction of proprietary closed access fiber to the premise networks in a few metro areas of the United States, Google's core business is and remains advertising. FTTP is simply a better way to put ads on more screens and in front of more eyeballs, albeit an expensive one -- hence the limited deployment of Google Fiber.

And what better way than the leading advertising medium: high (and super high) definition TV. Over the next few weeks, Google Fiber will test targeted TV ads over its Kansas City build. The ads will run during existing ad breaks, along with national ads, on live TV and DVR-recorded programs and will be matched to the viewer based on geography, the type of program being shown or viewing history, according to a March 20 post by Google Fiber. Subscribers will be able to opt out of seeing ads based on viewing history, according to the post.

In addition to generating advertising revenue, the TV ads will also help offset operating costs, particularly the rising costs of TV programming. Google recently increased the monthly price of its TV and Internet bundle to $130 a month, according to a report in the Kansas City Star.

Advertising on large screen devices is critical to Google's business according to this analysis which notes online stores that advertise via Google are not optimized for small smartphone displays.

US federal government will have to provide substantial funding for Internet infrastructure construction

Obama: This federal council will jumpstart broadband - CNET: Obama first introduced this idea in January, when he traveled to Cedar Falls, Iowa to announce his plan to promote "Broadband that Works," a public-private effort to help more Americans get access to speedier broadband.

As part of this new push, he urged the FCC to strike down state laws to ensure communities could build or expand their own 1 gigabit-per-second networks, which offer downloads 100 times faster than conventional connections.

The new council will include 25 federal agencies and departments that will work with private industry to understand how the federal government can help communities increase broadband investment and reduce barriers to deployment. The council will be co-chaired by the U.S. Commerce and Agriculture departments. The council will report back to Obama, within 150 days, with the steps each agency will take to advance these goals, including specific regulatory actions or budget proposals.

The biggest barrier to Internet infrastructure investment is private market failure on the sell side. That's been patently obvious for more than a decade; it doesn't take more than two dozen federal agencies and departments to ascertain that. The existing dominant U.S. commercial model for providing telecommunications services is based on selling "subscriptions" to and "owning" the customer, consistent with the natural monopoly market that favors large vertically integrated legacy telephone and cable TV providers.

Its primary weakness is it is wholly dependent on ARPU and ROI which don't easily pencil out in much of the nation and aren't likely to given that labor costs that make up about 70 percent of network deployment and maintenance expense are not declining and don't benefit from economies of scale. This produces an all or nothing scenario and lots of winners and losers -- with millions of premises stuck in the latter category for nearly two decades.

If the United States is to have modern telecommunications infrastructure in the 21st century that serves all Americans wherever they live or operate their businesses, the federal government must commit big as it did for electrification, water, telephone and highways in the 20th century. The states don't have the funding to do the job on their own such as Maine, for example, where the state has appropriated only $1 million to fund Internet infrastructure projects that won't go very far when billions are needed. In New York, $500 million in matching public funds isn't attracting much interest as legacy incumbent providers stand warily on the sidelines.

What will be truly interesting is what regulatory actions and budget proposals will be recommended by the newly created federal council. On the regulatory front, the Federal Communications Commission has already acted by deeming the Internet as a common carrier telecommunications service. That leaves it up to fiscal strategies, which should include substantial technical assistance and infrastructure funding for the states along the lines of existing block grant and federal highway programs. Or in recognition that the nation is a generation behind on construction progress, the federal government could built it directly on a crash program basis with early completion bonuses for contractors. Then operate the network on an open access basis, contracting for operations and maintenance and leasing out access to providers under long term contracts.

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.