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. 

Ocala, Florida, is one of those communities that doesn’t think twice about offering high-quality Internet access to businesses and residents. They’ve been doing it for decades and, when media coverage around gigabit connectivity began to expand, they were a little surprised because they had been offering similar services since the early 2000s. The benefits were nothing new to Ocala.

A Familiar Story Taken to Its Logical Conclusion

We touched based with Arnie Hersch, Senior Broadband Engineer for the City of Ocala, who shared the story of the network. Arnie has spent more time working on the network than anyone else in Ocala.

As in many other communities, Ocala started deploying fiber between its municipal utility facilities, including electric substations and water and wastewater locations, to improve inter-facility communications. In 1995, copper connected the city’s substations for SCADA operations. The copper was aged and had been struck by lightning, which negatively impacted its ability to perform; decision makers at the utility decided to replace the copper with fiber optic lines. As they finished deploying that year, Arnie joined the city's telecommunications utility; one of his primary objective was making the most out of the new fiber network.

First, Ocala connected all of its 52 municipal facilities in order to improve connectivity and cut costs. At the time, city offices still used dial-up connections for Internet access. Within two years, Arnie had switched the city to an Asynchronous Transfer Mode (ATM), which allowed them to use the new infrastructure for computing and voice applications. The change opened new doors for the city.

Plans for a fiber-optic middle mile network to serve the Brazos Valley in Texas are firming up and the project should be up and running within two years, reports KBTX from Bryan and College Station. The network will also have a fixed wireless complement.

Healthcare First

The $22 million network backbone, funded through the FCC’s Healthcare Connect Fund and the Brazos Valley Council of Governments (BVCOG), will first connect healthcare providers such as hospitals, schools nurses, and jail clinics.

According to the April 2015 Network Plan from the Brazos Valley Council of Governments, 62 percent of the population in the proposed service area live in rural areas with poor access to quality healthcare. Twenty percent of residents in the region are 60 years of age or older. Texas A&M School of Public Health, one of the partners in the project, completed a study that indicated high percentages of chronic conditions in residents in the region. In 8 of 12 of those measures, the results were worse than the national average. In some cases, the rates were twice as high as national averages.

Jobs Ahead

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:

Time Warner Cable recently fought to prevent a collaborative project in Maine from receiving $125,000 in state broadband funding, reported the Bangor Daily News. 

We reported in December that Old Town, Orono, the University of Maine, and GWI had been awarded ConnectME funds. The collaborators earmarked the funding for a stretch of about 4 miles of fiber which could serve about 320 subscribers and would ultimately be integrated into a much larger network for businesses and residents. The network would connect to Maine's Three Ring Binder network.

Old Town and Orono want to establish gigabit connectivity to a nearby industrial area to transform it into a technology park for economic development purposes. Several businesses, including a health clinic that, have expressed interest in setting up shop in the planned development.

Old Town and Orono formed OTO Fiber, an independent entity to have authority to design, install, maintain, and manage an open access network. In typical fashion, TWC took action prevent local citizens and businesses from ever capitalizing on a gigabit, rather than work with the municipalities to deliver TWC services over the publicly owned infrastructure.

The ConnectME Authority voted in TWC's favor, based on the arguments as presented in an earlier Daily News article:

The company argues that the agency only has the ability to give grants in areas it deems “underserved” or “unserved,” and that projects getting grants should overlap with less than 20 percent of the customers of an existing provider.

Award-winning supercomputing apps, medical research, economic development, and quantum computing advances. What do they all have in common? They all depend on the DubLINK network running underneath Dublin, Ohio, a suburb on the Northwest edge of Columbus. The city of 43,000 people has 125 miles of fiber optics in the ground, both within its own boundaries and in the form of fiber purchased by the city within metro and regional networks. 

DubLINK began in 1999 as a public private partnership with the Fishel company to build an institutional network. In the wake of the 1996 Telecommunications Act, Dublin worried that a recent massive investment of $70 million in streetscaping would be undone as competing providers dug up newly paved streets to install fiber optics. To avoid this, the City signed a franchise agreement with Fishel to install a multi-conduit system, with the city receiving some conduit for its own use.  

Using 1.25” conduits installed in the city’s existing sewer system, the network runs for 25 miles underneath Dublin’s business district and connects six city buildings, who use their own lit fiber for data and voice services, eliminating expense leased line fees. This has allowed the city to save approximately $400,000 per year for the last 12 years in connectivity and information technology expenses.

In 2004, Dublin spent $3.5 million to purchase 96 strands running 100 additional miles through Columbus FiberNet, bringing the total length of the DubLink network to its current 125 miles. FiberNet is a duct system that runs throughout a significant portion of central Ohio, including Columbus and its surrounding suburbs.

Last fall, Culver City hired a consultant to develop a design and business plan for a possible fiber network project. Recently, prominent business leaders and parents of local school children have publicly expressed their support for a municipal network.

Culver City, also known as "The Heart of Screenland" is situated in west L.A. County, surrounded primarily by the City of Los Angeles. Approximately 39,000 people live in this community that is beginning to draw in the tech industry. In addition to Disney's Maker Studios, Apple owns Culver City's Beats Electronic, known for high-tech headphones. Culver City wants to stay current to compete with Santa Monica, home to a number of tech businesses that connect to its publicly owned City Net.

The L.A. Weekly reports billionaire Patrick Soon-Shiong, owner of NantWorks, has encouraged city leaders to move forward with the project. His specific request is that five business districts be included in the network deployment. NantWorks, located in one of those districts, provides cloud-based operating systems to support telehealth. According to the article, Soon-Shiong is rallying other business leaders:

Soon-Shiong has been encouraging other business owners in the area to support the plan, which is expected to come before the City Council sometime in October.

"He feels this is key," said Mike Sitrick, a spokesman for Soon-Shiong. "He’s talked to various city officials and told them how important he thinks it is, not only to his business, but to attracting additional businesses to Culver City."

Local elected officials report positive feedback as the city reaches out to determine interest in the project:

"We're still attempting to gauge the degree of interest," said Councilman Andy Weissman, though he added, "I'm confident it's going to happen."

Indiana's Metronet Zing winds its way through South Bend, Mishawaka and St. Joseph County providing dark fiber service to businesses, government and education. The project started as an economic development initiative when community leaders in the area realized that the high cost and lack of high-speed connectivity in the area kept businesses away.

Project Future, the economic development organization serving South Bend, Mishawaka and St. Joseph County until 2012, studied the potential benefits that might flow from better telecommunications in the region. The nonprofit inspired the county Chamber of Commerce, local government, nearby universities, healthcare, and businesses to develop a new nonprofit network model. The 100 mile network offers a dark fiber open access model that encourages competition, keeping prices in check. Nineteen carriers deliver services over the network. Average price for 1 gig service is $1,000 per month.

In the early 2000s, South Bend leaders wanted to take advantage of the regional long-haul fiber that runs directly under South Bend. There was very limited access to fiber connections in the area from providers and rates were high. St. Joseph's County, city government, and the University of Notre Dame needed better, faster, more reliable telecommunications.

A study commissioned by nonprofit Project Future confirmed what community leaders suspected. Education, economic development, healthcare, research and a better quality of life in South Bend depended on the community's access to a dark fiber network. Project Future developed a plan that would involve public investment in an open access dark fiber network. Community leaders joined together to form nonprofit St. Joe Valley Metronet, Inc. in 2004. Metronet's purpose was to build the infrastructure the region so desperately needed. Revenue would be passed back to the community through reasonable rates.