Telehealth helps people stay in rural areas – policy makes is affordable

Business North talks about the scarcity of traditional healthcare access hurting rural communities in Minnesota…

The disparity of home health workers and personal care attendants is an ever-widening gap with no clear solutions in sight, and that is something Teri Fritsma Mogen, a Minnesota Department of Health senior workforce analyst, noted should be a major concern for the trickle-down effect it will have.

“If you don’t have enough home health workers to allow people to age in place, older folks will have to move to nursing homes or assisted living and that just moves the workforce shortage to another area,” she said.

Rural northeastern Minnesota has the highest need for specific mental health providers in the entire state, specifically alcohol and drug counselors and licensed mental health therapists, according to Fritsma Mogen.

“Including Duluth for alcohol and drug counselors the region has the second highest ratio in the state, and if you take Duluth out of that equation the ration is through the roof with 8,000 people to every one drug and alcohol counselor with the average in the metro roughly 2,000 to one,” Fritsma Mogen said.

Including Duluth and beyond, there is one psychiatrist for every 20,000 residents, far short of the statewide average of 11,000 residents to one psychiatrist.

And the impact of telehealth, especially since policy has helped offset costs of telehealth…

In 2015 the Minnesota legislature passed the Telemedicine Act, increasing the list of professionals eligible to bill for telemedicine practices, including physicians, nurse midwives, clinical nurse specialists, dentists and psychologists. The Telemedicine Act took effect at the beginning of 2016, with some provisions not fully operational until 2017.

Louise Anderson, director of the Carlton-Cook-Lake-St. Louis Community Health Board said the use of telemedicine to meet client needs is expanding significantly.

“Meeting remotely with clients is especially important in rural areas of the region where mental health providers are less accessible,” Anderson said.

She noted video conferencing technology is also serving to fill a crucial gap for public health nurses. Providing Direct Observed Therapy (DOT) via video conferencing to monitor patients taking oral medication for treatment of tuberculosis has fulfilled some need efficiently.

“One example of this in our region was public health staff time and travel savings of 2.5 hours per day by using (video) conferencing with a patient who lived in a remote area of the county,” Anderson said.

Carlton County Public Health and Human Services director Dave Lee has been an advocate of using the Health Insurance Portability and Accountability Act (HIPPA) compliant video conferencing technology called “Vidyo” in Northeast Minnesota.

In the Region 3 Adult Mental Health Initiative Area several counties are represented: St. Louis, Lake, Cook, Carlton and Koochiching, which comprises 23 percent of the state’s land and contains only 6 percent of the population. That geographical area also happens to represent an area where health challenges such as depression outstrip any other major health concerns two to one.

“All the data points to mental health being the number one chronic health condition in that part of Minnesota and the benefits of using telehealth tools to redirect resources quickly are huge,” Lee said.

Despite working on expanding video conferencing for mental health treatment over the last six years, Lee is frustrated with how slow the system has been to take hold. The technology exists, but he said attitudes are slow to change and minor legal and technical obstacles can take a long time to overcome.

Sen. Westrom co-authors broadband expansion legislation

The Minnesota State Republican Caucus reports…

Senator Torrey Westrom (R-Elbow Lake) is co-authoring legislation to expand broadband access in Greater Minnesota. Senator Westrom, Chairman of the Senate Committee on Agriculture, Rural Development, and Housing Finance, held a committee hearing on January 16 to discuss rural broadband expansion. Recently, his committee was given jurisdiction over the funding of rural broadband in Minnesota.

“Ranging from health care, education, to small businesses, broadband access is essential to our way of life in the twenty-first century,” said Senator Westrom. “I consistently hear from rural residents and small business owners that a lack of broadband limits their ability to flourish in Greater Minnesota, much like a lack of electricity did 75 years ago. We need to continue to address that problem and I look forward to spearheading that effort this upcoming session.”

Senator Westrom has long been a proponent of rural broadband expansion, authoring multiple bills that funded projects to expand broadband access in Greater Minnesota. This session, he joins a bipartisan group of senators authoring legislation to invest $70 million in broadband expansion over the next two years.

During the hearing Westrom’s committee held, experts from the broadband industry testified that the state program helps leverage private and federal broadband investments, multiplying their benefits many times over. Additionally, they stated the state program “works like a scalpel,” filling-in broadband coverage gaps where private or federal funds do not provide enough resources.

“Broadband expansion benefits everyone, from students doing homework to businesses in Greater Minnesota,” added Senator Westrom. “By working across the aisle, we can improve our state, economy, and way of life.”

Broadband expansion in Lincoln County through Woodstock

The Marshall Independent reports…

An expansion of broadband Internet possibilities in Tyler is scheduled to take place this year.

The community will be offered city-wide broadband service through Woodstock Communications. It will become part of the company’s efforts to use 21st century fiberoptics and wireless networking on behalf of rural southwest Minnesota communities.

Woodstock Communications General Manager Terry Nelson said the concept of city-wide service for Tyler has been on the drawing board for the past several years.

The upcoming project will resemble existing city-wide Woodstock networks in Westbrook and Balaton. They are one component of an expansion process that has also included targeted broadband service to schools, hospitals and other organizations. …

Woodstock Communications plans to install infrastructure for Tyler city-wide broadband during 2019, with a service start-up scheduled to begin in December.

Woodstock will have some competition…

Woodstock will become the third provider to offer Internet plans to Tyler residents. The others are Frontier Communications and Mediacom, both of which rank in the top 10 of all providers in terms of total nationwide subscriptions.

The article also includes interesting histories of several providers in the area.

How does a bill become a law in MN and you can you contact about it?

Last week I went to an event that talked about how to become civically engaged. They did a concise reminder of how a bill becomes a law in Minnesota. It’s more detailed, less musical that, I’m just a Bill but as we all start looking more closely at broadband  and other bills I thought it might be helpful:

Also I thought it would be helpful to remind folks of the details of the broadband bill that was introduced last week. The quickest description – both the House and Senate are looking for $35 million a year for the next two years (the biennium).

In the House the bill is HF7.

In the Senate the bill is SF9.

You can subscribe to updates from each committee if you want to track what’s happening. Just a little civics reminder for MLK Jr Weekend!

Overview of rural broadband program for MN Agriculture and Rural Development and Housing Finance

Yesterday the Agriculture and Rural Development and Housing Finance learned about Minnesota’s rural broadband program from Danna Mackenzie at the Office of Broadband Development, Anna Boroff, Minnesota Cable Association, Brent Christensen, Minnesota Telcom Alliance and Nancy Hoffman with Minnesota Rural Broadband Coalition. The Agriculture and Rural Development and Housing Finance will be discussing broadband this year

You can listen to the meeting : http://mnsenate.granicus.com/player/clip/3122?view_id=2

Danna Mackenzie at the Office of Broadband Development

  • The state has been working on broadband since before 2008
  • The policies and programs have been iterative as we have learned
  • Four strong components:
    • Speed goals (set in 2010)
    • Mapping – to measure success
    • Office of Broadband Development – esp in DEED
    • State funding
  • The state is seeing success but some counties still need help. Four counties have less than 50 percent (Aitkin, Fillmore, Pine and Yellow Medicine) access to 25/3 access. We may need new strategies to fix this. There are feasibility studies and/or proposals for improvement in three of those counties)
  • Much talk about the maps

Question from Kari Dziedzic: When you talk about 100 percent of household have access – are you looking at affordability?
Right now we only talk about availability from at least one option. We do have resources to track affordability

Question: Do you know which schools don’t have access?
I can get the list. There’s an area in the West Central part of the state. The other school is northwest angle.

  • We now track gigabit access too

Question: What kind of investment do we need to make – wires or equipment?
The program is tech neutral so we don’t have a specific answer. But we seem to fund a range that includes equipment, tower, wires…

  • We launched a speed test for the state to track consumer experience. We have about 6,000 tests but that’s not enough to draw conclusions

Question: DO some people ask for less than 50 percent match?
Applications get extra points if they are able to match more than 50 percent

  • People often ask how state and federal funding works together. We do use maps of federal funding to make decisions. We don’t go into areas that are working on enhancements but we have partnered with new projects to increase speeds of federally funded projects

Question: IN regards to feds, do you have info on how much they have spent or houses reached or miles built?
I don’t have that info today. There are multiple streams of funding.

Question: How much does it cost to cover a township?
It depends on the type of technology.

Question: How much to cover the state?
The Broadband Task Force came up with a number to serve 25/3 – not 100/200 but the number $35 million annual until goal is met.

Question: In early days we had communities that were being undersserved? Have we tightened that up? (Have we called people on their challenges?)
We are aware of those concerns. The state policy prioritizes the unserved versus underserved.

Brent Christensen, Minnesota Telecom Alliance

  • Representing 44 providers
  • I wasn’t a fan of the grants when first introduced; but I was wrong. The Office has done a great job of helping providers – such as with MNDOT permitting. They were slow but we’re getting them expedited.
  • People recognize our success in other states. Many other states are using the MN model or looking at them. But of the success is focusing on unserved.
  • The grant have formed unusual partnerships. Such as – Big Stone County…

Question: Is fixed wireless a way to serve farms and rural areas?
Yes

  • Broadband is like a water pipe. Broadband is the pipe and internet is the water.
  • We use the cloud now – much like the mainframe environment back in the day.
  • Byte is 2-3 paragraphs of text…
  • Broadband is measured in the amount of data delivered per second
  • We want to get the internet to grow faster
  • 25 Mbps Download / 3 Mbps Upload
  • Defining broadband is a moving target; it has been redefined on a regular basis

Question: Why 25 down and 3 up? Why is it slower to upload?
The internet was original built on telephone network. Then there was more of a need to download than upload. SO they focused on download – because the telephone lines were only so big. As we transition to fixed wireless and fiber that is less of an issue.

  • What technologies are out there
    • Telephone companies – first put on telephone lines / started with dalipup to DSL to FTTH. The closer we can get people to fiber, the faster the connection. Many built fiber to the node and are now closing that gap.
    • Cable put it on cable lines / They have creted hybrid solutions and will do FTTH
    • IN the last 12 years – wireless has emerged – but really wireless connections are wired until it goes from tower to your phone.
    • Fixed wireless – will put up an antenna at your house and connect to that.
    • Satellite – uses a dish that pushes connection from home to satellite and back

Question: so the object is to get fiber as close to the house as possible? How fast is copper?
Copper will maintain 4060 Mbps down to 4500 feet

Question: Do you track how much goes to telecom vs cable vs wireless?
I can tell you who has recevedi what funding but not how many customers?

Questions: I see gaps in the maps. Are you worried about those gaps?
Yes. I belive broadband will get just about everywhere. But there are pocket, where you just can’t make a business care to make it happen and that’s where the grant program makes a real difference. It helps us get to the corners. We won’t need state support forever; how long we need it depends on how mcuh you invest per year. We only ever got to 98 percent phone coverage. We now have a way to maximize federal funding with state match.

Question: What is it like to work with the counties?
It’s all  over the map. You need to find a local unit of government to support broadband but it can happen at county or township level – such as Sunrise Township.

Question: What do you do when part of a community are not served? Does that make it more expensive?
It’s cheaper to extend an existing network than build an entirely new network.

Question: Can we get a workshop for potential grant applicants? Do they need a provider?
We do run workshops at the beginning of every cycle. There’s not requirement that a community have a provider in mind when they come into the workshops. Many do have a provider or the provider is taking the lead but the program is open to all. We offer assistance.

Anna Boroff, Minnesota Cable Assocaition

  • All major cable companies and serve almost 1 million households
  • We appreciate the Office of Broadband Development
  • We have invested $1 billion in broadband since 2011
  • Many cable companies have gig access – Mediacom serves many rural areas
  • There are areas where you can’t make a business case to serve broadband; grants have helped members serve these areas
  • Counterparts in other states are envious of the Minnesota model
  • We thinking spending money in unserved areas is important
  • CAF 2 – Midco received funds to expend fixed wireless service – they are getting 100/20 speeds
  • Adoption is an issue; members have programs to help make broadband affordable to low income customers

Question: More people choose to not get broadband than don’t have access?
Yes more choose not to get access – maybe due to affordability or other reasons

Nancy Hoffman, Minnesota Rural Broadband Coalition

  • We have more than 70 members
  • Our priorities are
    • Base funding for the grants in DEED
    • Continue to support the Office of Broadband Development
    • Re-establish a MN Broadband Task Force
    • Funding grants at $70 million per biennium

Timberjay editorial asks legislators to make broadband a priority

Serving Northern St. Luois County, the Timberjay ran an editorial yesterday promoting legislative attention on broadband…

With the Legislature now in session, improving telecommunications in rural Minnesota should be near the top of the to-do list for lawmakers. As legislators continue to grapple with how to bring reliable, high-speed Internet access to less-populated parts of the state, they must recognize that the lack of investment by regulated providers, like Frontier Communications or CenturyLink, is currently the biggest hurdle to achieving widespread broadband access.

The Department of Commerce highlighted the challenge earlier this month when it released the results of a months-long investigation into the quality of Frontier’s service to the roughly 100,000 households it serves in the state, including many here in northeastern Minnesota.

They highlight first hand experience with Frontier to make the case that local providers may be better positioned to provide local service…

If the big corporate providers like Frontier and CenturyLink aren’t willing to do the job, both legislators and state regulators need to start clearing the way for alternatives. They need to develop financial incentives that make it possible for smaller local companies, or locally-based cooperatives, like Bemidji-based Paul Bunyan, to extend their services into communities that the big corporate providers would just as soon ignore. We’re already seeing interest from alternative providers, such as Jackson-based BackForty Wireless, which recently installed a wireless service in Orr. Brainerd-based Consolidated Telecommunications Company has also been exploring possibilities in Tower and Ely.

Unlike the big corporate providers, locally-based companies are generally far more responsive to outages and questions from users. The cooperative Paul Bunyan has an excellent reputation for customer service in the communities it serves. And when you have a problem, you can quickly get a live person on the phone who actually speaks Minnesotan.

The bottom line is this: the technology exists to bring high-speed communications to even the smallest of our area communities. The big corporate providers, however, appear unwilling to make the investments to bring these technologies to our area. If they won’t do it, the Legislature and state regulators should clear the way for others to serve rural parts of the state. We’ve waited long enough.

Next Century Cities Launches Resource to Help Communities Become Broadband Ready

Sharing the resources from yesterday…

Today, January 16, 2019, Next Century Cities launched Becoming Broadband Ready: A Toolkit for Communities. This new resource is a guide for communities that are seeking solutions to connect residents to broadband. The launch event took place at The Brookings Institution in Washington, D.C. from 1:00 – 3:00pm ET. 

A panel of community leaders, including Dr. Robert Wack, City Council President, Westminster, Maryland; Don Patten, General Manager, MINET; and McClain Bryant Macklin, former Director of Policy, Office of Mayor Sly James, Kansas City, Missouri, discussed their work to improve connectivity for their constituents and the potential of the toolkit to help similar efforts in other communities.

Across the country, mayors and community leaders are looking for solutions to connect residents to fast, affordable, and reliable internet access. Becoming Broadband Ready was developed with input from Next Century Cities’ member communities and features best practices and strategies from a diverse array of successful projects.

The toolkit acts as a comprehensive first-stop resource for community leaders by outlining the most important considerations and action steps for communities beginning broadband expansion projects. These “building blocks” for a successful project are broken down into clear, concise sections that are presented in chronological order, with the most fundamental ingredients first and more nuanced considerations later. Next Century Cities will continually update this resource to address evolving technology and new challenges that may arise.

View Becoming Broadband Ready in full here: 

https://nextcenturycities.org/becoming-broadband-ready/

Watch a recording of the launch event here:

https://livestream.com/internetsociety/broadbandready