Transcript: Community Broadband Bits Episode 336

This is the transcript for episode 336 of the Community Broadband Bits podcast. In this episode, Christopher speaks with industry analyst and podcast host Craig Settles about telehealth. The audio version of this episode is available here.



Craig Settles: Come to Danville because we have excellent healthcare, thanks to our broadband and our healthcare facilities' use of the broadband. So that becomes an economic development tool.

Lisa Gonzalez: This is episode 336 of the Community Broadband Bits podcast from the Institute for Local Self-Reliance. I'm Lisa Gonzalez. This week, industry analyst and host of the Gigabit Nation podcast, Craig Settles, takes some time to talk to Christopher about telehealth. For the past few years, he's been focusing on the ways communities can use high-quality Internet access to make high-quality healthcare available to folks in rural and urban areas. In this conversation, Craig and Christopher discuss how telemedicine has evolved into telehealth and the differences between the two. They also discuss the way telehealth improves the quality of life for people with access to it and the way access to telehealth creates economic development opportunities. They also discuss the perks of telehealth to network owners because the ability to use the infrastructure for these applications increases interest for patients, healthcare providers, and investors. Craig also explains how local communities can approach specific challenges related to healthcare regulations. You can see more of Craig's work at Now here's Christopher and Craig Settles on telehealth and economic development.

Christopher Mitchell: Welcome to another episode of the Community Broadband Bits podcast. I'm Chris Mitchell with the Institute for Local Self-Reliance up in Minneapolis, Minnesota, talking with my friend Craig Settles out in Oakland. Welcome to the show, Craig.

Craig Settles: Ah, thank you. I'm very happy to be here, and we've been talking broadband stuff for like, what, eight, nine years and stuff, so . . .

Christopher Mitchell: Yeah, 12. Well, I guess I've been in it for 12. I've probably known you for eight or nine. You know, it's a funny thing because there's a number of people who I think, just because I'm so loud and obnoxious, that they assume I've been around since the beginning. But you — you go way back. Well before I got started in this business. How did you get into this?

Craig Settles: It was a fluke. I was writing a book where I was interviewing CIOs to talk about wireless technology, and the Philadelphia announcement that they were gonna build Wi-Fi citywide caught my attention because Philadelphia generally is not on the leading edge of technology, you know, at that time. And I'm from Philly and so I said, well, why don't I just include the CIO for the city of Philadelphia to talk about the process of how they built their plan for Wi-Fi. Right, so it was all about the planning thing — how do you make this thing work? And that was such an interesting story, I felt, that I wrote a book about just that. And I have been in this business since 2005 with the launch of, you know, how do you do the planning for citywide — at the time it was citywide Wi-Fi, but it just basically morphed into broadband across the board and whatever kind of technology that you use to get that Internet connection to as many people in your city or town as possible.

Christopher Mitchell: And you've been doing this as part of your own company — CJ Speaks, right? You're the official president of it.

Craig Settles: Right. At the time, it was I was primarily working with private sector companies, and I had moved from software and general kinds of high-tech to wireless in 2001. And I got really interested in the concept of citywide wireless or broadband because of a company I worked with that was called Ricochet, and they had the concept of hanging these Wi-Fi transmitters on telephone poles throughout the city. And that whole concept really caught my eye, and through a couple of weird changes and so forth, I got into the broadband, as I mentioned, with the Philadelphia announcement. And so here is where I've been.

Christopher Mitchell: More recently, you've been focused on telemedicine, doing some research on that. That's what we're gonna be talking about today. Let me ask you, what do you mean by telemedicine? When you're researching it and writing your articles about it, what does it mean?

Craig Settles: So right now, we're talking about telehealth, right? When we were talking about just the treatments and being able to talk to your doctor and so forth, that was telemedicine if you will, right? But people have now realized that broadband, basically, can affect various aspects of healthcare, including obviously treatments and so forth, but [also] using the broadband to facilitate radiology — you know, your MRIs, your x-rays and so forth. Being able to get information from a crash site or some sort of major activity where it makes sense to get medical data from or about individuals to some other hospital or clinic, and [there] can be a number of ways that they can do that. And then also just like passing the knowledge of medical practice and so forth that the average person can pick up. So when you look at all of these aspects of healthcare and knowledge about healthcare and so forth, and you put a nice little label, call it telehealth, and then you add in the broadband element of it, where you're basically trying to get people to understand that the Internet is a great way to transport all types of medical data, and so that becomes a sort of discipline called telehealth. And you know, why this makes sense is that telehealth, or healthcare if you want to look at it that way, that can be impacted by these community networks. Just about everybody at some point is going to be a recipient of healthcare, or you're going to know somebody, you're going to be responsible for someone, and so healthcare and telehealth is a integral part of life as we know it. So if I can use the broadband network to facilitate that healthcare delivery or just the knowledge of healthcare and medical terms and so forth, there's a value for that. And that's what I've been trying to focus on and educate people about in the last year in particular.

Christopher Mitchell: Let me get a little bit provocative. I feel like a lot of people, they hear it and they think, oh, talking to your doctor over video chat. That's like the obvious one, it strikes me. What else? Like, is there anything in your research where you're thinking, oh, interesting — I didn't think of that as telehealth, but we can do this interesting thing that will have major health outcomes.

Craig Settles: Well, for example, I had a stroke a couple of years ago, and when I went to the hospital — well, the take-in — my neurologist that runs the Alameda hospitals stroke center, she was at her home half an hour away. But she was able to see everything that the emergency doctors saw, all the stats and so forth, and she was able to start treatment within 35 minutes. And so what got me to thinking was that if I didn't have that Internet connection, I wouldn't have been able to survive, right? So if I look at all of these rural areas, low-income urban areas, and so forth, the ability to get needed medical care is crippled by just the fact that they're at a distance. They're somewhere in, you know, Appalachia or what have you, where they don't have good medical care. Well broadband can be the instrument that facilitates not only your doctor visit, which is the more common thing, but chronic care — being able to have a people who are elderly being able to live at home rather than being in an institution because if they have the broadband connection, they can get their various medical care that way. You have a lot of chronic illnesses, such as diabetes, where there's a regimen that you have to follow, right? It's easier to do that when you can do it from home with your access to medical personnel, whether it's a specialist, whether it's a local doctor or what have you. But it affects more than just your random visit for a cold or strep throat. We're talking changing our method of healthcare so that it is enabled by broadband, high-speed Internet access, and that's the driving force, I think, for why you'd want to build one of these networks, you know, besides the obvious. There's all kinds of healthcare practices that can be facilitated by having all of your people [connected], whether it's wireless or fiber or some variation thereof, that has significant financial impact. It has an economic development impact, a quality of life [impact]. So we talk about, you know, all the entertainment aspect of broadband, but there's some serious healthcare types of practices that can be done that improve your overall quality of life in a small town — or a big town even, for that matter.

Christopher Mitchell: Of that I have no doubt. I think we're gonna talk in a few minutes about aging in place, where there's obvious, you know, tremendous implications for that, and local economic benefits and things like that. But let's take the perspective of the network owner. How does telehealth — how does that help me raise the capital and pay off the debt to operate and build my network?

Craig Settles: Well, one, if I am building a network to just deliver connectivity, that has a value, and you can go find money for it and so forth, right? But if you are saying to potential investors or even like government agencies, we're going to transform the quality of healthcare in our city by having a broadband network, where the endpoint is the improved medical care, a lot of people get really excited about that, both from a government standpoint, but also philanthropic organizations, community foundations, and so forth. So from an aspect of raising money, I think you can get more "umph" for your effort if you're telling people that the primary reason we're doing this is that we're going to improve the quality of healthcare in that area. The second aspect is, it becomes an economic development issue. Like if I look at Danville, Virginia, right? So they built a network initially to drive issues of unemployment. So that was their initial goal, but the hospital got together with all of the clinics and so forth, and they created sort of a sub network, if you will, where all of their services were connected and so forth. And so they were able to market this aspect of, you know, come to our town — whether you're talking about an individual or a business coming into town — come to Danville because we have excellent healthcare, thanks to our broadband and our various healthcare facilities' use of the broadband. So that becomes an economic development tool.

Christopher Mitchell: I like the point about Danville because there's something that they can do as the network owner. I presume that in connecting their healthcare facilities, for instance, they can connect them to each other using basically a private network. You know, they're not sending that traffic over the public Internet, I'm guessing, in part because HIPAA has all kinds of regulations as to how you treat this data. But what I'm really curious about is, if you're a community that wants to get a lot of enthusiasm, perhaps from community foundations, to demonstrate that you can improve local health outcomes, are there things you have to do that are different from what you would normally do if you were just building a business model to operate a fiber network?

Craig Settles: I would look at it as very similar to hooking up your hospitals in general. The applications that you would use for telehealth — those and those vendors would address the issues of HIPAA security and so forth. And so, I wouldn't necessarily expect the community network owner to be responsible for that, right? They would basically put the connections together. I think in the case of Danville, they created separate strands specifically for customers that wanted to have a private network within the bigger Danville network. When it comes to the specific application, there are the requirements for the provider of those applications. Or maybe in a better way to explain it — in Arkansas, they have a public, statewide network. They have vendors that work with one of the main hospitals to create a telestroke application, but in that build out of the application, all of these issues related with HIPAA and so forth [are] addressed there, not necessarily [by] the infrastructure owner.

Christopher Mitchell: Right. That makes sense.

Craig Settles: So I think that that's the important thing to keep in mind. You know, what I'm advocating is not that the network owner get into the business of telehealth, but they want to facilitate getting all of these components pulled together in some organized way. Now, you may have a telehealth vendor, such as Docity, which is D-O-[C]-I-T-Y, where they will work with a city's network owner to create a marketing or a joint marketing activity, right? So they might provide a discount specifically for the network subscribers, so anytime they use Docity's product, the network owner — you know, the city — gets maybe some "spiff," I think, is the sales term, and then the network subscriber may have some sort of bonus or a discount or what have you. So in that respect, it's a partnership, again, not the city getting into the business of telehealth. But I think that what is important is I would look at it the same way doing a needs analysis and a plan for an overall general network. I do a similar kind of needs analysis and say, what is it that the constituents would like? You know, are they interested in aging in place? Are they you concerned with being able to access specialists and so forth? And by getting that need on paper and how many people have that, then you as the network owner can say to the telehealth community, we have 2,000 users. We have 40 percent [who] are concerned with aging in place and all that means. We have 20 percent that are concerned with getting in touch with their family doctor and so forth. And now you can then draw the telehealth community in because you've done the research to figure out what it is that people need. You can figure out also, you know, should we be doing a telehealth in the schools using the school nurses? The small businesses, would they be interested in having telehealth at their premise? As you get all of this type of information, you can help, number one, figure out how to build your infrastructure, the broadband infrastructure, but also what kinds of partnerships and other activity that you want to either encourage or actually do more hands on. For example, Chattanooga, they did a pilot using a particular vendor's product, Docity, and they did six months of testing that product with several of the local doctors in Chattanooga and also some set of subscribers. Chattanooga saw a value in telehealth as something that they could facilitate in one way, form, or fashion with their network.

Christopher Mitchell: And this is not something that's primarily an engineering or a networking challenge then. It's really social. It's talking to businesses, to hospitals, to your subscribers, and things like that it sounds like.

Craig Settles: Well it is, but like for example, I had a conversation with Dublin, Ohio. They have a network that primarily goes to businesses and institutions, right? For a network such as that, and there are a lot of those in the U.S., if the constituents said, you know what, we really want to do telehealth. We want to make it easier. We want to make it affordable. We want to make it reach all of our citizens in our particular area. At that point, then you have to figure out, well, do you use fiber to get to those homes? Do you do a fixed wireless infrastructure and so forth. So there can be, indeed, an engineering component depending on, you know, what you're starting with and what is that you want the network to be able to do. If you're concerned about getting people on board for telehealth, you might want to have some additional engineering to make the redundant infrastructure to make sure that — like you and I just experienced, where CenturyLink went out. You don't want to have people doing healthcare, and all of a sudden, the network doesn't function at that particular time. So you want to have probably some element of redundancy as part of the engineering process, but probably built in more so than, you know, we want to build a separate network.

Christopher Mitchell: Craig, as we're wrapping up here. I think, you know, we see this a lot in the press. Mental health is increasingly a concern. How does that intersect with what we've been talking about?

Craig Settles: If you're going to facilitate that type of telehealth, you've got to make sure that your network can handle, among all the other things that the home might be doing, a video connection, right? So if you're planning for like maybe there's two main applications that people are gonna do, like Netflix and something else — you know, education. Well now you've got to figure out, if you have a lot of people doing mental health types of telehealth, then you've got to make sure that you have that infrastructure in place that will support those types of activities. I think that's really what you're looking at is that if I want to have different types of applications that are telehealth focused, then I've got to have an infrastructure that can handle that for half of your population, two-thirds of your population. You know, you have to sort of do research to figure out, you know, how much of your population would be affected by this kind of application, but you want to build accordingly, is what I think it comes back to.

Christopher Mitchell: Craig, let me ask you, for people who are interested in learning more, where should they go? Where are you writing about this? And we'll get to your podcast in a second, but where are you writing about this?

Craig Settles: On my website which is There are two reports on telehealth and broadband. My text blog talks a little bit about telehealth, and then I have a number of articles that are in my section on columns and articles. I would say as a general resource, many of the states have a telehealth resource center, and you can talk to them about the telehealth world within that particular state. And I think it would be a very good way to get an education on telehealth but also understand how it's being used or how it's being applied in your particular state.

Christopher Mitchell: And then let's close by just noting that you are also a podcast host. What's been happening with your show lately? I see episodes popping up in my feed from time to time.

Craig Settles: Yes, I do have Gigabit Nation, and in fact there is an interview I did with one of the doctors that is involved with the Chattanooga pilot program. And so that's actually really good, if you're interested in telehealth from the doctor's perspective or a doctor within a place where you have a community broadband network, that would be a good interview to listen to.

Christopher Mitchell: Great. Well thank you, Craig. I really appreciate you coming on to share your research with us.

Craig Settles: Glad to be of assistance.

Lisa Gonzalez: That was Christopher with analyst and speaker Craig Settles on telehealth and economic development. We have transcripts for this and other podcasts available at Email us at with your ideas for the show. Follow Chris on Twitter. His handle is @CommunityNets. Follow stories on Twitter. The handle is @MuniNetworks. Subscribe to this podcast and the other podcasts from ILSR, Building Local Power and the Local Energy Rules podcast. You can access them wherever you get your podcasts. Don't miss out on our original research; subscribe to our monthly newsletter at, and while you're there, please take a moment to donate. Thank you to Arne Huseby for the song Warm Duck Shuffle, licensed through Creative Commons, and thanks for listening to episode 336 of the Community Broadband Bits podcast.