Imagine a world where your electronic health record contains a video from an upper GI endoscopy and your follow up consultation occurs via video link. Practitioners are collecting and sharing greater amounts and types of data, as well as engaging patients in new ways. The more data that need to flow through the health care system, the bigger the pipes needed and the better they need to perform. But some health care providers face a connectivity gap – meaning the mass-market broadband infrastructure available to them is beneath a certain bandwidth threshold.

Last week, we published a paper on the connectivity analysis in the Health Care section of the National Broadband Plan. This paper explains the methodology and underlying assumptions used to determine the broadband connectivity gap for health care providers ranging from solo physician practices to hospitals. The gap matters because it affects doctors’ ability to move data and use health IT solutions that can help them better treat their patients. It also affects patients’ ability to access care – especially specialty care.

This analysis is a starting point for figuring out how big the pipes need to be and where they’re lacking. Based on extensive input from industry on the types of health IT solutions and the bandwidth and performance measures needed to support them, we profiled different health IT usage scenarios across various delivery settings and created some connectivity guidelines. We then matched these guidelines against the available mass-market infrastructure to identify potential connectivity gaps.

Due to the limitations of currently available data, the model is only able to estimate available infrastructure and does not address price disparities. Although comprehensive availability and actual purchase data at the provider level are not currently available, we hope the federal government will work together to get such data, as recommended in the National Broadband Plan.

Not withstanding, the value of the model is that it helps us understand that certain segments of providers face greater challenges than others in securing adequate infrastructure to support health care delivery. It also informs our efforts for targeted follow up and enables us to work with partners across government to quantify actual provider-level connectivity. We hope to build on this initial analysis to ensure that every doctor has the broadband infrastructure needed to provide the highest quality care for his or her patients.

Three years ago, the FCC launched its Rural Health Care Pilot Program to learn how best to fill an important need: providing broadband connections to isolated rural health clinics.   The need is very real. Broadband can provide rural health clinics with real-time consultation, diagnostics, training and other services from big-city teaching hospitals and specialists over high-capacity Internet lines.  That can save lives, time, & money while improving health care in remote areas.  But the robust networks needed to support these services are often lacking.  So the Pilot Program set out to learn how to make these networks available, using hands-on experience from 62 pilot projects.

This week, I had the pleasure of joining California Gov. Arnold Schwarzenegger and U.S. Chief Technology Officer Aneesh Chopra at the launch of the second-largest of the 62 projects, the California Telehealth Network.  With funding from the FCC and a 15% match from the California Emerging Technology Fund, the project will initially build a network backbone and connect 50 health care facilities in the state. Ultimately, the project will around 800 facilities in remote and Tribal areas.

This project is a model of what the FCC is trying to foster across the country.  Comprised of a consortium led by the University of California Office of the President and the U.C. Davis Health System, the California Telehealth Network worked with small, regional telehealth operations around the state to forge a unified project.  In the end, organizers almost doubled the number of providers on the network, and effectively demonstrated how the FCC can play a positive role in advancing state health networks.  

We have learned a lot from this project and from leaders like Dr. Thomas Nesbitt from U.C. Davis,  and CTN Director Eric Brown.  We will be applying these lessons as we develop a new Rural Health Care Program to replace the Pilot, and hope to do an even better job of supporting this increasingly important component of health care at remote hospitals and clinics across the country. 

Chairman Genachowski visited Seattle Children’s Hospital Friday to witness first-hand how broadband can help deliver quality health care efficiently to areas that lack it. Back in 2001, Seattle Children’s started a telemedicine program to provide better access to specialized pediatric care throughout the Pacific Northwest. The hospital also has been a leader in telepsychiatry, which is one of the most effective ways to increase access to psychiatric care for individuals living in underserved areas, according to the American Pychiatric Association. 

My mom is a former librarian who taught me (what little I know) about html. She is online constantly for work and leisure—she shops, does research, checks her email, and streams PBS Frontline documentaries from her computer to her TV. She is technology savvy (and money-conscious) and when I told her that 80% of broadband users in the United States do not know the speed of their connection, she only paused a moment before telling me: “Oh, I have no idea what we get.” After recovering from my shame, I asked her to guess what she thinks she needs, at which point she hung up. So I did a little background for her:

Like most broadband consumers, my mom spends more time online and conducts a lot more of the business of her day-to-day life online than she did in 2002, when she first got broadband. While developing the National Broadband Plan, and in crafting policies for the future, the Commission is interested in projecting how consumer preferences and use of broadband Internet connections will change over time.  Before we figure out what our networks should be able to do in the future, however, we need to have some idea of what we as consumers already use and expect from our connections.

The chart below shows the bandwidth requirements for the range of applications consumers and businesses use today. From basic email to enhanced video teleconferencing.

So a user like my mom—who wants to have several browser tabs open, along with her email while watching a streamed TV show—probably requires download speeds between 1 and 4 Mbps. For her, video requires faster speeds than she needed for simple web browsing and e-mail, but most of the common video sites require relatively limited bandwidth; Hulu.com, for example, recommends a downstream bandwidth of 1,000 Kbps for smoothest playback while CNET TV recommends 2.5 Mbps minimum downstream speed for 720p HD videos and PBS offers both 800 Kbps and 300 Kbps streams.

My mom is probably slightly above average (she’ll love me for saying this) in her bandwidth requirements—according to comScore, in 2009, e-mail and web browsing accounted for almost 80% of the median consumer’s data usage.

Armed with this information, and in an attempt to get a ballpark figure for her subscribed speed, I sent my mom a link to Testmyisp.com to test her actual download and upload speeds. Based on data collected by the FCC and others, we know that in 2009, the mean and median advertised download speeds consumers purchased were between 7 and 8 Mbps. Yet, the Commission also learned, from Akamai and comScore, that U.S. consumers experienced an average of 4 Mbps and a median speed of 3 Mbps—about 50% of the advertised speed. Now I can tell her she should probably subscribe to an advertised service between 2 and 8 Mbps—if she ever calls me back.

We are busy at the FCC developing proposals to reform key aspects of the universal service fund.  I’ve been fortunate in recent weeks to be able to travel outside of D.C. with several FCC colleagues to listen and learn from a broad cross section of stakeholders that share a common goal of promoting innovation and investment in broadband across America.  I attended the NARUC Summer Meetings in Sacramento, where I participated in several panels, including a discussion of the National Broadband Plan and its USF recommendations and a discussion of the regulatory framework for broadband services. Our colleagues at state public utility commissions have a keen interest in what’s going on in Washington, DC and how the FCC’s actions might impact citizens in their states.  

We also spoke with rural telephone companies at the OPASTCO summer meeting.  Several of the companies we talked to have deployed all fiber networks throughout their service areas offering, while others are in the process of building out their networks.  The companies we spoke with typically offer three to five tiers of service, with overall take rates ranging from 20% to 70% and many customers purchasing the lower priced, lower speed packages offering 1.5 Mbps to 3 Mbps downstream. 

The Washington Department of Information Services hosted a jam packed day of meetings with Tribal government leaders and local officials (including representatives from school districts, the City of Seattle, the Washington State Library, the Department of Social and Health Services, the Department of Commerce, Noanet, Public Utility Districts, and many others), who are working hard to maximize the availability and use of broadband in their communities to advance health care, education, and economic development. State and local officials were eager to discuss the challenges of extending broadband to particular isolated communities in the Washington State. 

We learned about a not-for-profit health center that has raised matching funding to establish a critical access health care facility on the San Juan Islands that would enable health care professionals to treat patients through live imaging delivered via broadband, rather than transporting people to the mainland via helicopter or ferry.   The Colville Tribe talked about how they are hoping to receive stimulus funding to extend broadband on their reservation so that their people can find new ways to learn a living in the wake of high unemployment after the closure of timber mills that sustained the community for so many years.  Noanet – which has received $85 million in round one of stimulus funding and has another $55 million in projects in due diligence – highlighted for us on a map where they will be extending middle mile facilities in the state.  We heard about how broadband enables areas of the state that historically have survived on tourism to develop a cottage industry of software developers and others who remotely provide digital efforts for the movie industry.  We also spoke with the Gates Foundation about their ongoing commitment to improving public access to broadband in libraries across the country.

We recognize the magnitude of the task and know that it’s too great for the FCC to accomplish on its own.  I’m convinced that we have to work closely with our state, local and Tribal government partners, as well as the private sector and non-profits, in discussing how to reform USF to advance broadband for local communities. They know what’s on the ground.  We’re all in this together.

Just over two weeks after the Commission released its report to Congress finding that broadband is not being deployed on a reasonable and timely manner to ALL Americans, we’re already starting work on the next report. The FCC is required to produce this broadband deployment report annually, and today is the statutory deadline for releasing a Notice of Inquiry seeking input for next year’s version. 

Commonly called the 706 Report after the section of the statute that mandated it, the Sixth Broadband Deployment Report reached its conclusions after taking a hard look at the wealth of new data available gathered during development of the National Broadband Plan and from ongoing FCC data collection, as improved by policies adopted in 2008.  The report also updated the FCC’s decade-old speed threshold for broadband, from 200 Kbps to 4 Mbps, and relied on a more realistic methodology for determining how many of the areas are unserved. 

But as you’ll see in the Notice of Inquiry for the Seventh Broadband Deployment Report, we’re committed to staying abreast of the fast pace of technological change by asking for public comment on whether our new speed standard continues to be reasonable or if  it should be adjusted. We also seek comment on how we can sharpen our analysis and make the best use possible of our data.

So while next year’s 706 Report may be different from this year's, one thing that is sure to stay the same: our commitment to assessing whether all Americans have access to the robust broadband service they need to find jobs, get educated, and stay connected to their communities.