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Expert Opinion: Telehealth Provides Antidote for ‘Help Wanted’ in Rural America

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Rural Americans are sicker, poorer and more likely to be uninsured than their urban counterparts. Vital human capital links in our nation’s information and healthcare supply chain are missing in rural America, and we need more skilled health care professionals in those communities.

Telehealth capabilities offer an antidote to the rural health care conundrum by remotely connecting rural patients with health care services locally or miles away. Telehealth video conferencing and remote patient monitoring are increasingly essential applications for providers in rural America, reducing transportation as a barrier to care, creating operational efficiencies and improving care quality.

A doctor’s visit by video conference is a common application. In order for information to get from the patient to the provider, data travels along broadband telecommunications lines to medical equipment or other hardware and is then accessible to the medical provider.

Who makes sure the equipment is working properly in the rural community? And who fixes it when it’s not? IT technicians who are woefully in short supply in rural communities. The absence of IT skills has profound implications on the wellbeing of tens of millions living outside urban areas.

The national shortage of medical providers is well documented. Primary care providers necessary to treat newly insured patients under the Affordable Care Act are in short supply. The health IT professionals who support medical personnel are similarly scare.

A lagging IT skillset coupled with a dramatic increase in reliance on new technologies threatens to exacerbate disparities between rural and urban America. A recent study by the Health Information and Management Systems Society (HIMSS) concluded that demand for qualified health IT workers is at its highest point ever with no solution in sight. A 2013 report by Research and Markets estimated that global telemedicine market demand will grow by 18.5 percent through 2018.

The federal government, through the Federal Communications Commission, Department of Health and Human Services and other agencies is investing heavily in telemedicine programs and the telecommunications broadband enhancements necessary to power the transmission of information. But government funding for new technologies is not enough. We still need IT professionals in place to maintain and troubleshoot the technology.

Bolstering the IT skill set in rural America has the potential to promote economic growth as well. In Mississippi, where health outcomes rank near the bottom of all states, an innovative program aims to create healthier communities and stimulate economic growth. The Delta Regional Authority and University of Mississippi Medical Center initiated a partnership last year to create a telehealth delivery and education center with the goals of increasing patient access to care and expanding medical training statewide. The program will create 200 new jobs.

The first step to solving any problem is recognizing you have one, and key policy makers in Washington D.C. know it. They’ve taken steps to work with industry groups like COMPTEL, the Competitive Communications Association, private companies such as Rural Health Telecom and others to initiate a nationwide focus on solving the skill set problem.

Rural Americans should not be second class citizens when it comes to health care. It’s time to ramp up the effort to add missing human skills to the technical knowhow of telehealth.

Editors’ Note: The views represented are a commentary by Tim Koxlien, CEO, Rural Health Telecom, and do not necessarily represent the views of Broadband Breakfast. We encourage other perspectives on broadband by emailing commentary@broadbandcensus.com.

Expert Opinion

Pierre Trudeau: Life in the Trenches, or Lessons Learned Deploying Broadband in MDUs

Behind every great wireless network, is an even greater wired network.

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The author of this Expert Opinion is Pierre Trudeau, president and CTO of Positron Access Solutions.

Imagine community-wide Wi-Fi an industry standard in multi-dwelling environments. This is possible through the deployment of G.hn technology.

G.hn, an International Telecommunications Union (ITU-T) standard, is an access technology for operators looking to simplify their access network with an “Ethernet-like” technology. 

With G.hn, operators deliver advanced services, such as gigabit high-speed residential internet and 4K internet protocol television without the high capital and operational expenses associated with a fiber retrofit. Each G.hn subscriber port supports up to 1.7 Gbps of dynamically allocated bandwidth for near-symmetrical gigabit services. This enables providers to deliver a gigabit internet service to each apartment inside a multi-dwelling unit or a multi-tenant unit without the cost, complexity and delays associated with in-building fiber installation.

As deployed by Positron Access, G.hn is increasingly used by our partners to sustainably improve connectivity in multifamily communities. These partners offer in-depth analysis of cabling specifics and electrical as-built drawings of active properties to design a custom wiring solution to accommodate, rather than replace, each property’s unique, pre-existing infrastructure. 

Proven Benefits of Fiber Service Extension Applications

Our partners leverage their expertise of the Positron G.hn Access Multiplexer to enable MDU property management companies to offer lightning-quick, cost-effective, and dependable Gigabit internet speeds to their tenants in MDUs. Property management companies can then improve their service levels without the need for any building retrofit, which can be expensive and disruptive. Property management companies expand the services they deliver with an impressive ROI and minimal capital outlay.

The transformative nature of G.hn applications will make community-wide Wi-Fi an industry standard in multi-dwelling environments. With the broader installation of smart building systems including cameras, sensors, environmental controls, and asset tracking systems as crucial amenities for an improved resident experience, residents will come to view community Wi-Fi systems as another essential building asset. Owners that do not keep up with these developments will see the quality and capitalized value of their community suffer. 

The Process

Positron’s partners have developed a proven process to ensure a successful and sustainable deployment in existing brownfield properties.

In-Depth Site Surveys

The site survey process begins with a careful analysis of each property’s unique needs. Built from the ground up, the solution is designed to accommodate each property’s unique blueprints and connectivity requirements. Site surveys are extremely important to ensure systems are updated in the most economical way for each property’s connectivity requirements.

Minimal Interruption

The deployment process is aligned to complement, rather than disrupt, established occupancy turn processes. With little to no downtime, the installation enables property-wide connectivity, giving residents the opportunity to immediately connect to the internet, without reauthorizing as they move about the property.

Sustainable and scalable

Positron’s partners provide subscribers with an extensive support team, dedicated to each property’s continued development and operation, designing customized, future-proof solutions to ensure the network is both a sustainable and buildable foundation for upcoming technologies like Web 3.0, Wi-Fi 7 and 5G. G.hn technology is designed to be adapted and improved upon to grow in tandem with each property, working together to accommodate any future needs that may arise.

Lessons Learned

The installation of the GAM solution by Positron’s partners highlighted the importance of a careful pre-deployment site survey and this is applicable to coaxial and telephone wiring re-use with G.hn.

For MDUs where the telephone wiring will be re-used, the continuity of pairs currently used for VDSL2 or even telephone service, there is no additional validation required since G.hn is permissive and will operate without further pair qualification or grooming.  For unused pairs, it is important to perform a continuity test using the same tools and techniques used for the last 20 years for xDSL.  Bad pairs can then be identified and repaired as needed.

When re-using coaxial cabling, understanding how each room or apartment is connected is important.  Most MDUs are cabled with “home run” coaxial cabling to a common location where taps or splitters can be installed in a point to multipoint mode to reduce the connectivity cost of each subscriber.  Unlike CATV and DOCSIS, G.hn does not require coaxial amplifiers and fine tuning with attenuating taps.  If co-habitation with CATV is required, the G.hn signal shall be injected downstream of the CATV/DOCSIS amplifier with a simple 2:1 combiner device.  Otherwise, if migrating to IPTV or streaming, these amplifiers and attenuating taps shall be removed as they are no longer useful.

For some properties, the option of a comprehensive site survey is not always an option.  For instance, a property of about 450 doors no longer had up to date coaxial cabling diagrams.  In this case, rather than spending days “toning out” each coaxial drop with specialized equipment to document the coaxial infrastructure, we recommend installing the GAM devices in each wiring closet and pre-install the G.hn endpoint devices in each room or apartment and to record serial number of each device against the room or apartment number.  Using the endpoint auto-detection feature for each coaxial port of the GAM, it is then simple and efficient to use this information to fully document which door is served by each coaxial segment.

Overall, we learned that G.hn is robust and rather forgiving with regards to “less than stellar” existing wiring.  You can plan fiber extension by re-using the existing wiring in your building without too much concern about potential complexity, cost, or performance issues.

Pierre Trudeau is the president and CTO of Positron Access Solutions and a seasoned Networking and Technology Executive with over 30 years of experience. Pierre founded Colubris Networks, a leader in advanced Wi-Fi solutions for Wireless ISP, Carriers and Enterprises in March 2000. He provided business and technology services to several companies until January 2013 when he joined Positron Access as its Chief Strategy Officer. This Expert Opinion is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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Broadband Mapping

Garland McCoy: Some State Attorneys General Are Preparing to Take the FCC to Court

While some will “cash out,” other state broadband officials will seek the full measure of federal broadband infrastructure funds due.

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The author of this Expert Opinion is Garland McCoy, Executive Director of Precision Ag Connectivity and Accuracy Stakeholder Alliance

Let me start by saving the time of those state broadband officials who are going to accept the recently released FCC Broadband Map Data at face value and take NTIA’s “cash out,” and in doing so, forgo participation in the available FCC challenge process. For those state broadband officials, the insights, and recommendations I provide below will be of little interest to you. 

If the past is any prelude to the future, the Internet Service Providers will use the same challenge criteria to successfully throw out the crowdsourced and bulk data that states have gathered for their own maps. As I detailed in my recent article on Broadband Breakfast, the FCC published specifications for its challenge process on September 15, 2022.

This directive gives ISPs authority to challenge data drawn from their respective service territories, leaving states with little choice but to accept the FCC’s map. The only notable exception is California, which has put in place its own statewide device-driven data gathering methodology, and we consider its data as likely challenge-proof. 

Not all is lost for states seeking to challenge the FCC’s maps

But all is not lost for other states. By the end of the first quarter of next year I firmly believe there will be some state broadband officials who will seek to pursue the full measure of federal broadband infrastructure funds due them, and not simply acquiesce to a smaller portion of funds that is supported by the flawed FCC map.

I base this assumption on new methodologies now available to states, which will bring the same type of credible validation and metering to broadband service at the end-user level that has been available, and required, for decades with other important utilities such as electricity, water, and natural gas. In other words, these methodologies will allow consumers to determine if they are getting true broadband speed connectivity – and frankly whether or not they are getting what they are paying for.

These state broadband officials have reviewed the recently released FCC broadband map and have compared it to their own respective state broadband maps. And not surprisingly, what they are finding is an FCC map that vastly overstates the amount of broadband connectivity in their states, and in doing so, vastly reduces the amount of federal dollars that state will receive. And these differences are significant. It could mean as much as a loss of tens of millions of dollars in smaller states and up to half a billion dollars or more for larger states. 

What these state officials will ultimately find is irrefutable evidence that many of the ISPs doing business in their state have been systematically providing significantly less service speed and quality than their customers’ terms of service agreements stipulate.

States are beginning to work with their state attorneys general on lawsuits

Knowing this and considering how the FCC has not run a transparent and straightforward process – and has used the calendar in a way to run out the clock on states, you can see why some state broadband officials have begun working with their state attorneys general to not only prepare to challenge the FCC data, but to take their case to court. 

Consider the calendar issue alone: The FCC released its long-anticipated new map data on November 18, 2022, and is giving states until January 13, 2023, to respond – with the major holidays of Thanksgiving, Christmas, and New Year’s falling in the interim.

If you are one of these state broadband officials currently considering your options to challenge and/or litigate, then we can play a vital role in your efforts. You will need to ensure that your state broadband map data is litigation-ready by putting in place bullet-proof methodologies and highly credible network monitoring devices/meters. This data can be used to support your case for the full broadband infrastructure funding that your State is entitled to receive.  Additionally, these same devices and methodologies can be used to support any state lawsuits against ISPs for false/deceptive advertising and breach of the spirit, if not the letter, of customer “terms of service” contracts. 

Importantly, our device-driven methodology also focuses solely on the premium customers of ISPs in rural counties of a state, which establishes what FCC refers to as the “available service” for a given ISP’s service territory. 

You have the power to truly close your state’s broadband connectivity gap by fully utilizing the historic level of federal infrastructure funding that has been set aside for this purpose, which in turn will bring accountability and equity to broadband network services for your citizens. 

If you want a citizen-centric partner in these initiatives, please visit our website and contact me at the email address provided below. PAgCASA is a non-profit organization focused on promoting rural prosperity, and we are utilizing industry standard network monitoring/metering devices, same as used by the largest ISPs, litigation-ready methodologies, and an expert team and partnerships to accomplish our goals.

Garland T. McCoy, Co-Founder and Executive Director of Precision Ag Connectivity and Accuracy Stakeholder Alliance, is a long-time non-profit veteran in the fields of technology and telecommunication policy having served as Founder and CEO of the Technology Education Institute. Garland was recently an adjunct professor at Syracuse University’s iSchool, teaching information policy and decision making, and can be reached at garland.mccoy@pagcasa.org. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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Broadband Mapping & Data

Jeff Miller: Tools to Manage the Next-Generation Network Buildouts

Service providers that use GIS applications are able to reduce design time by 80 percent.

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The author of this expert opinion is Jeff Miller, Synchronoss Technologies CEO.

Today’s digital world is driving the insatiable need for fiber networks and connectivity, thus the thrust for widespread broadband buildouts and deployments worldwide. Broadband connectivity is the heartbeat for mobility, cloud applications, voice, video, and social media, not to mention home automation, IoT, and smart cities. As a result, service providers and operators are investing heavily in infrastructure, claiming their 5G networks are the largest or fastest or most reliable.

Initiatives like the Rural Digital Opportunity Fund are aimed at bridging the digital divide and fast-tracking investment to deploy high speed fixed broadband service to rural areas and small businesses that lack it. The Federal Communications Commission’s $20.4 billion program requires that networks stand the test of time by prioritizing higher network speeds and lower latency.

A key element in the implementation of RDOF-backed projects is broadband mapping. The Federal Communications Commission is in the process of updating its current broadband maps with more detailed and precise information on the availability of fixed and mobile broadband services. The Broadband Deployment Accuracy and Technological Availability Act, signed into law in March 2020, requires the FCC to change the way broadband data is collected, verified, and reported

As carriers build, expand, and upgrade their fiber network infrastructure, a great deal of planning is required, along with documenting the intricacies of design and engineering processes.

Streamlining and automating network planning and design processes through software can deliver accurate and timely network info for service providers, increase efficiency, and create opportunities for reducing costs.

GIS based systems are replacing volumes of paper, and outdated static CAD, Excel and Vizio files. They offer sophisticated tools to manage all aspects of network design and infrastructure management. Working with many service providers that use GIS applications, they are able to reduce design time by 80 percent and drastically cut other capital expenditures.

Automation is key

Having to rely on a system of manual processes to manage the fiber network makes it increasingly difficult to scale. Fortunately, with the introduction of automation into the network management process by utilizing an accurate physical network inventory in addition to geographic information system mapping, scalability becomes a much easier task.

Continuous planning and engineering tasks can ultimately become automated through software implementation. Automating network fiber management creates significant business value by shifting a service provider’s approach from reactive to proactive. A comprehensive and updated database for network architecture quickly allows for scenario analysis and capacity planning. Sharing automated processes across different organizations becomes much simpler and improves collaboration while reducing errors. This can allow staff to shift their focus to more pressing operational activities thus making the network more reliable.

Integration between different systems

Whether it is your enterprise GIS or outage monitoring system, it should be easy to interact with third-party systems to get the most out of the network data. Ideally, you should be able to receive an outage notification and use that location to track down the network and pinpoint the root cause to act and quickly resolve the situation before customers notice. This can help save time, money, and guarantee customer satisfaction.

Mobilize network data and increase field worker productivity

Utilizing a fiber networking and planning solution enables network information to be shared easily and quickly between the field and office to provide access to the information they need when they need it at any given time. Enterprise-wide access can provide timely and accurate network information for a wide range of communications service providers.

When it comes to service providers, expanded visibility into a network yields a greater overall awareness of the network. Automating third-party data exchange processes with accurate and up-to date inventory can optimize performance for field workers and guarantee customer satisfaction. Improved access to data can increase ROI by allowing cable locators and field techs to receive accurate confirmation before they arrive at a job. In the end, there will be fewer mistakes which ensures happier customers.

The right tools can result in improved scalability, reduced time to revenue, lower operational costs, and actionable insights that can be gleaned from network data.

Jeff Miller serves as President and CEO of Synchronoss Technologies. He previously served as President for IDEAL Industries Technology Group, following a 16-year experience with Motorola Mobility where he was Corporate Vice President of North America. Miller also serves on the Board of 1871, Chicago’s largest start-up incubator, and on the non-profit Boards of Aspire Chicago and Junior Achievement. This article is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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