Deficient telecommunications infrastructure limits growth of telehealth

Just What the Doctor Ordered: Telehealth Poised for Growth: “Rural healthcare providers (HCP) continue to suffer from limited access to broadband speeds necessary to fulfill their rapidly expanding public and private Internet network needs vital for telehealth communications with patients and HCPs,” said Tim Koxlien, founder and CEO of Rural Health Telecom. “Upgrading rural health care provider broadband networks will dramatically enhance their ability to implement new telemedicine technologies and increase access to electronic medical records. This will ultimately enable them to better serve patients through streamlined operational efficiencies, expanded patient service access, reduced costs and improved quality of care.”

Koxlien also noted that high equipment installation costs and a workforce deficit of trained IT personnel as two challenges facing telecom accessibility. “Many local service providers are reluctant or unwilling to expand into these underserved markets because of the costs associated with designing and implementing rural networks, [and a] lack of funding,” Koxlien said.

Disruptive forces bringing U.S. telecommunications infrastructure to an inflection point

Several disruptive forces are building toward a tipping point heralding a new era of construction, operation and regulation of telecommunications infrastructure in the United States. 

• The realization amid exponential growth in bandwidth demand that the nation needs to rapidly fiber up its legacy metal wire infrastructure and should have begun the work 20 years ago.
• The growth of local fiber to the premise infrastructure projects inspired by Google Fiber and the associated push back against state laws restricting the ability of local governments to build and operate telecom infrastructure.
• The obsolescence of bandwidth-defined "broadband" delivered over legacy metal wire infrastructure as an extension of plain old telephone service (POTS) and cable TV.
• The Federal Communications Commission's potential classification of Internet infrastructure as a common carrier telecommunications service amid growing popular sentiment that premise Internet service is a utility that should be universally available. 
• Excessive commercial risk that limits fiber infrastructure deployment to discrete neighborhoods.
• The recognition of the large moral hazard risk associated with public policy reliance on incumbent promises to build out the footprints of Internet infrastructure in their service territories.
• Growing unease with Comcast gaining excessive market power and getting a lock on most U.S. Internet premise infrastructure.
• The breakdown of the triple play "smart pipe" vertical business model due to high video programming costs and the rise of a la carte Internet video offerings.

High TV content costs threaten the “triple play” commercial Internet infrastructure business model

Television programming costs associated with the “triple play” (TV, Internet, voice) offering of legacy telcos and cable companies are the primary business risk facing the subscription-based, closed access, “own the customer” infrastructure business model employed by the legacy telephone and cable companies as well as Google Fiber.

Those costs are steep and threaten the viability of commercial fiber to the premise deployments that depend on future cash flows from service offerings – which include TV – to cover CAPex and provide ROI to investors.

So dear are TV programming costs that Google Fiber’s Milo Medin described them “the single biggest piece of our cost structure” and “the single biggest impediment" to further expansion. The Wall Street Journal reports costly TV content has prompted some small cablecos to scrap the triple play offering and reposition themselves purely as Internet and VOIP (Voice Over Internet Protocol) providers. Over the top (OTT) TV offerings by Sony and Dish Network are also similarly struggling with the high costs of TV programming.

Susan P. Crawford’s book Captive Audience: The Telecom Industry and Monopoly Power in the New Gilded Age describes the self-reinforcing TV programming market dynamics that cement the dominance of the big subscription-based incumbent telcos and cablecos – and Comcast in particular for live sporting events. These large players can afford the high TV programming costs. But large scale notwithstanding, it’s not TV for all since the big legacy telcos and cablecos cherry pick their service areas, leaving lots of consumers redlined and without Internet TV since they opt not to build the infrastructure to deliver it.

One possible way around this negative circumstance would be for the OTT Internet TV content players to organize consumers into large regional purchasing pools and cater to smaller providers as well as open access community fiber networks operated by local governments and utility cooperatives. That would shift market power to the purchasing side while at the same time bolstering these home grown Internet infrastructure players.

Spiral Internet gearing up for fiberoptic network in Nevada County | TheUnion.com

Spiral Internet gearing up for fiberoptic network in Nevada County | TheUnion.com: “Years ago, every home in the U.S. had copper wires put in, going to each home, but we never got wired again for the 21st century,” he said, referring to fiber. “That’s the kind of network we need.”

Very true words spoken by Spiral Internet CEO John Paul as his Nevada City, California company soft launches fiber to the premise infrastructure serving 2,900 households and 300 businesses with deployment planned for 2015-17.

US Telecom Association wants 'archaic' regulations gone | TheHill

US Telecom Association wants 'archaic' regulations gone | TheHill: Steve Davis, chairman of the board of U.S. Telecom, said some of the regulations cited "don't apply to cable companies or any of our competitors, and to the extent that they ever served a purpose, that purpose has long since evaporated."

The group pointed to a number of regulations they want to avoid, including requirements that companies "separate local and long-distance business, and requiring traditional phone companies to continue the provisioning of obsolete technology."

The group cited a speech Wheeler gave in February in which he noted that a large percentage of investment recently by telephone companies went to "maintaining the declining telephone network, despite the fact that only one-third of U.S. households use it at all."

"The future regulatory environment should be one that is based upon the world as it exists today," the group’s president and CEO, Walter McCormick, told reporters. "That is sort of like the overall theme we think public policy should move towards. This petition is a little tiny baby step in that direction."

The world of POTS (Plain Old Telephone Service) is still very much alive in much of the United States, where some 19 million homes and small businesses still rely on the publicly switched telephone network (PSTN) and dialup wireline Internet service. As long as it exists, regulators will be hard pressed to scrap rules designed for POTS without a firm transition plan in place.

The Incumbent Local Exchange Carriers (ILECs) could potentially get more than they wish for in making this request. The Federal Communications Commission could respond by effectively saying, "OK, if you don't want to comply with outdated POTS rules, you are hereby subject to Title II of the Communications Act and thereby must deploy advanced telecommunications infrastructure throughout your service territories."

South Korea’s gigabit broadband woes should serve as object lesson for FCC regulators | Network World

South Korea’s gigabit broadband woes should serve as object lesson for FCC regulators | Network World: Private South Korean firms, notably KT (the former Korea Telecom), SK Telecom and the cable provider CJ Hellovision, became the principal participants in the gigabit project, with the government committing about 5 percent of the total estimated budget.

But by 2011, only a very small-scale 1Gbps pilot project with 1,500 households in five South Korean cities had been launched, all with government funding. None of the private firms could make a case for moving ahead, however, since they had not yet developed a business model to justify the scale of investment that the KCC had said would be necessary.

Three years passed without any indication of progress on the effort, leading many to believe that the plan had hit an impasse. Then in July 2014, Chairman Chang-gyu Hwang of KT, the dominant broadband provider in Korea, representing almost half of the country’s total broadband market share, called a press conference—an announcement that I hoped would be an encouraging milestone.

Chairman Hwang told those assembled that the company faced its first annual deficit in 2013 due to its sales declines in wired broadband, along with almost-flat growth in mobile subscribers. It was the worst time in the company’s history, one that he called a “devastating year of poor performance.” KT even had suspended new customer marketing for 45 days and asked 8,300 employees to voluntarily resign to help the company overcome this crisis.

The real object lesson here is commercial investment in high cost telecommunications infrastructure is fraught with substantial business risk. It's that business risk -- and not the risk of common carrier regulation as some such as this article warn -- that produces market failure that in the United States has left some 19 million homes and small businesses without wireline Internet access according to Federal Communications Commission estimates.

The Perennial Need for Speed | Light Reading

The Perennial Need for Speed | Light Reading: Vodafone, for one, sounds eager to get away from this obsession with the megabit flow. Matt Beal, the operator's head of technical architecture, envisages a time in the not-too-distant future when speed will be irrelevant and customers will not be able to distinguish between network technologies on that basis. "Customers will solely be focused on the service that we render -- its ability to be agile to their needs, and its ability to be relevant and personalized," he told UBB Forum attendees during his presentation.

Beal is correct in this assessment. Speed is important now because existing infrastructure is still largely metal wire-based and limited in the throughput it can offer. The pricing models of the legacy cable and telephone companies also reflect this, charging consumers more for higher speeds and imposing bandwidth consumption caps.

But as fiber to the premise providing excellent throughput replaces legacy infrastructure, speed will no longer be a distinguishing feature of Internet service for the vast majority of consumers.