Turns out broadband at speeds of 25/3 is too slow for business

Coming as a surprise to no one who uses the Internet, the US Government Accountability Office reports that broadband at 25 Mbps down and 3 up is likely too slow for business…

In a 2021 report, GAO found that some small businesses lack access to broadband, but may benefit from federal programs that fund deployment in rural areas. A nationally representative survey by Amazon and the U.S. Chamber Technology Engagement Center found approximately 20 percent of rural small businesses were not using broadband, with about 5 percent using a dial up connection. Small businesses likely benefit from the Federal Communications Commission’s (FCC) and the Department of Agriculture (USDA) Rural Utilities Service’s (RUS) funding to expand broadband deployment. For example, at the time of the 2021 report, FCC had awarded $19.7 billion since 2014 through components of its high-cost programs, and estimated it had served 9.1 million business and residence locations. Both FCC and USDA have also helped increase broadband speeds in rural areas. For example, USDA’s rural broadband deployment program, ReConnect, is mostly funding projects that propose to build fiber, which is generally associated with the fastest speeds available.

Much of the literature GAO reviewed suggests that FCC’s current broadband minimum benchmark speeds—25 megabits per second (Mbps) for downloading and 3 Mbps for uploading—are likely too slow to meet many small business speed needs. For example, a 2019 USDA report stated that as technology advances and volumes of data needed to manage agriculture production grow, speeds above of 25/3 Mbps will likely be needed. In July 2022, the FCC Chairwoman announced a proposal to increase the benchmark to 100 Mbps for download and 20 Mbps for upload.

Small Business Administration (SBA) officials told GAO that their agency supports broadband access for small businesses, especially for those in rural areas, through partnerships with organizations and federal agencies. For example, SBA partners with national organizations that offer technical assistance and training to small businesses on a variety of topics, including how to use broadband to support their business.

I recognize that it’s important to do the research to provide a point, but it feels like they should be looking at 100/20 or 100/100 not 25/3. Often the research impacts funding and funding is more forward-looking than 25/3.

Three new FirstNet Cell sites launch in MN: Deer River, Ely and Gary

AT&T reports on three new FirstNet Cell site. Here’s the info on each, starting with Deer River

First responders in Northern Minnesota are getting a major boost in their wireless communications thanks to the FirstNet® network expansion currently underway by AT&T*. We’ve added a new, purpose-built cell site located south of Deer River on Great River Road near Skunk Lake and the Mississippi River.

This new site will provide coverage when traveling along Great River Road (County 65 NE) and Minnesota State Highway 6 west of Grand Rapids in Itasca County. It will also give first responders on FirstNet – America’s public safety network – access to always-on, 24-hours-a-day priority and preemption across voice and data.

In 2021, we added a new site in Togo near George Washington State Forest in Itasca County. In addition, AT&T has added new cell towers in Itasca County to enhance mobile broadband coverage and help give residents, visitors and first responders faster, more reliable wireless service. These sites are south of Bigfork near Maple Lake and north of Bovey by Lower Balsam Lake.

Ely

First responders in Northern Minnesota are getting a major boost in their wireless communications thanks to the FirstNet® network expansion currently underway by AT&T*. We’ve added a new, purpose-built cell site located on the Echo Trail just north of Ely near Twin Lakes and Everett Lake.

This FirstNet site will provide coverage when traveling along the Echo Trail in the remote wilderness of northeastern Minnesota. It will also give first responders on FirstNet – America’s public safety network – access to always-on, 24-hours-a-day priority and preemption across voice and data.

This is the third FirstNet site in St. Louis County and the second on the Echo Trail. In 2021, we added a new site on the Echo Trail northwest of Ely near Meander Lake and Lake Jeanette State Forest – one of the first primarily powered by solar in the Midwest region. This site along the Echo Trail provided coverage to first responders who battled the Bezhik wildfire in May of 2021 just a few miles south of the tower. We also added a new site in 2021 in the Kabetogama State Forest near Kjostad Lake and west of Buyck.

Gary

First responders in northwestern Minnesota are getting a major boost in their wireless communications thanks to the FirstNet® network expansion currently underway by AT&T*. We’ve added a new, purpose-built cell site located near Gary and just west of the White Earth Reservation in Minnesota’s Red River Valley region.

This FirstNet site will provide coverage when traveling along State Highway 200 and State Highway 32 in Norman County. It will also give first responders on FirstNet – America’s public safety network – access to always-on, 24-hours-a-day priority and preemption across voice and data.

White House looks at Digital Asset and consumer protection

The White House releases the first-ever comprehensive framework for responsible development of digital assets. (Did you know 16 percent of adult Americans have purchased digital assets?) I’m going to borrow the Benton Institute for Broadband and Society recap…

Digital assets present potential opportunities to reinforce US leadership in the global financial system and remain at the technological frontier. President Biden’s March 9, 2022 Executive Order on Ensuring Responsible Development of Digital Assets outlined the first whole-of-government approach to addressing the risks and harnessing the potential benefits of digital assets and their underlying technology. Agencies across the government have worked together to develop frameworks and policy recommendations that advance the six key priorities identified in the Order:

  1. Consumer and Investor Protection –  issuing guidance, increasing enforcement resources, and aggressively pursuing fraudulent actors.

  2. Promoting Financial Stability – collaborating with financial institutions to bolster their cybersecurity capabilities and neutralize emerging strategic risks.

  3. Countering Illicit Finance – monitoring the development of the digital assets sector and working to expose and disrupt illicit actors.

  4. US Leadership in the Digital Assets Sector – leveraging US positions in international organizations to set standards for the digital asset sectors.

  5. Financial Inclusion – exploring a US Central Bank Digital Currency that enables access to a broad swath of US consumers.

  6. Responsible Innovation – developing a Digital Assets Research and Development Agenda and encouraging innovation in US-based, digital assets firms.

Hospital at Home Programs gaining popularity

Minnesota Monthly reports

Rachel Riedesel, population health manager at Allina Health, was in her final year of the Masters of Healthcare Administration program at the University of Minnesota School of Public Health in 2019. For her team capstone project, she partnered with leaders at Allina Health to design a program that would allow patients to receive hospital care in the comfort of their homes.

At the time, funding models and abundant hospital capacity meant there was little urgency to implement the program. All that changed when the pandemic hit. By then, Riedesel was working at Allina Health in the hub of the system’s COVID-19-related activity. “This came forward as an opportunity to increase hospital capacity while we were trying to serve our community and their needs,” Riedesel says. The Hospital at Home plan she had previously worked on was put in motion. “We were able to deploy the program in less than a month because of the plans we’d already prepared.”

Instead of being checked into the hospital, patients who participate in the program are sent home with biometric monitoring equipment. The kit includes a tablet, blood pressure cuff, pulse oximeter, and thermometer—all Bluetooth-enabled. Patients are continuously monitored, and their data is sent to a centralized nursing hub along with personalized parameters. If their biometric markers go outside of a preset zone, nurses are alerted to check on them. If needed, a nurse, physician, or paramedic may also be dispatched to the patient’s home. “We have an escalation process in place to ensure the patient is safe,” Riedesel says.

Allina’s program is now one of the fastest growing Hospital at Home programs in the country. To date, it has served roughly 3,700 patients in the Twin Cities metro and a few regional areas throughout the state. When the program started, 60% to 70% of the Hospital at Home patients were COVID-19-positive. In 2022, it’s closer to 40%. The bulk of the patients are now being treated primarily for other conditions, such as sepsis, chronic heart failure, chronic obstructive pulmonary disease (COPD), and post-surgery recovery.

“We continue to see equal- or better-quality outcomes for people who get to recover in their homes, with their loved ones,” Riedesel says. While in-patient hospital care is necessary for some acute conditions, hospitals are not without risk. The Centers for Disease Control and Prevention (CDC) estimates hospital-acquired infections account for 1.7 million infections and 99,000 deaths each year. “We want to make sure we’re providing the safest care in the safest place, and that can often be the patient’s home,” Riedesel says.

Telehealth saved lives of patients with opioid addiction

The Voice of Alexandria reports

Telehealth flourished during the pandemic, and now a new study shows it saved lives: The practice meant more people struggling with opioid addiction stayed in treatment longer and thereby lowered their risk of dying from an overdose.

For the study, researchers analyzed data among nearly 176,000 Medicare beneficiaries from September 2018 to February 2021. The analysis looked at telehealth services, medications for opioid use disorder, and medically treated overdoses among patients starting a new round of care before the pandemic compared to those during the pandemic.

More info

What did the study find? Patients in the pandemic group were more likely to receive telehealth services (19.6% versus 0.6%) and were more likely to receive medications for opioid use disorder (12.6% versus 10.8%). The findings were published online Aug. 31 in JAMA Psychiatry.

Even better than that, using telehealth services was linked to better adherence to medications, as well as a lower risk of having to be treated for an overdose, the investigators found.

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” according to senior study author Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse (NIDA).

Mapping can help determine broadband needs but mapping also opens door to broadband uses

This is a little beyond broadband today but at the 2022 Senior Executive Summit @ Esri UC, Governor Walz talks about the many uses of mapping, such as precision agriculture and electronic vehicles. (Did you know that Minnesota is fourth state in terms of miles of road – yet 18 in land size?) Broadband is going to be required to make the best use of maps. We need broadband to monitor and report back on crop nutrients; we need broadband to access to the maps to tell us where the nearest EV charging station is…

You can see his 25 minute speech on the ESRI site.

Top tips for the housing crisis in NE Minnesota – get better broadband

The Minnesota Reformer has 11 tips to increase housing stock in Northeastern Minnesota. I’ll just jump to number 7…

7. Support broadband expansion as quickly as possible.

Access to broadband moves a house from “the middle of nowhere” to the “center of everywhere” especially with the growing reliance and acceptance of remote work.

FCC takes back Auto Safety Spectrum for Wi-Fi

In an extreme case of use it or lose it, C|Net reports

The US Federal Communications Commission won an important battle in a fight to free up more unlicensed wireless spectrum for Wi-Fi devices.

A federal appeals court on Friday sided with the FCC in its decision to reallocate a big chunk of key spectrum for an expansion of unlicensed Wi-Fi use. The spectrum had previously been set aside for auto safety.

The US Court of Appeals for the District of Columbia rejected a legal challenge from the Intelligent Transportation Society of America and the American Association of State Highway and Transportation Officials seeking to reverse the FCC’s 2020 decision to repurpose about 60% of the 5.9GHz band spectrum block for unlicensed indoor use to help improve speeds and reduce congestion on 5GHz Wi-Fi networks.

UMD is bringing back telehealth counseling by popular demand

Fox21 Duluth reports

Back by popular demand, the University of Minnesota Duluth will offer telehealth counseling again this school year.

During the pandemic, many schools connected virtually with students. Last year, UMD launched its telehealth program, that offers remote mental health counseling.

Now, the university is bringing it back, after seeing how well-received it was by students.

Virtual, in-person, and hybrid counseling sessions will be available. Free of charge and covered by tuition.

People seemed to like it…

“Last year we did our initial appointments virtually and then we talked to students about what it was they wanted moving forward. We were a little surprised, we thought that everybody would want to be back in the in-person in the office, but that wasn’t necessarily the case for all people.”

Baribeau-Thoennes went on to say, it’s important to keep virtual options available, especially during the cold, Minnesota months.

“Our no-show rates for appointments went down. Somebody might be like “oh no my car is blocked in and I have to shovel,” and normally they might have canceled the appointment, but now they just call and say can I switch my appointment to virtual.”

There are policy hiccups…

The kicker is — providers can only give services in their licensed state. Meaning UMD students have to be in Minnesota to use the telehealth option.

Access to telehealth is a digital equity issue

I’ve been seeing an increase in articles on telehealth these days and they usually report that access to technology increases comfort and use of telehealth and that leads to easier access to healthcare – for doctor and patient. Rheumatology Advisor reports

For patients to participate in telehealth encounters, they have to use a number of proprietary, health system-specific portals and platforms. That can be challenging for many older adults and minority groups. Effective virtual care depends on digital fluency, meaning they need to be able to engage in all aspects of digital technologies, from accessing the internet to navigating telehealth applications and performing basic troubleshooting. Many people cannot do this, creating significant barriers to care and telehealth disparities for a large segment of the population.

Boston researchers say the technology has the potential to reduce health disparities, but it also is exacerbating structural inequities. “Telehealth is here to stay, and has the potential to actually improve care outcomes, enhance the patient experience, reduce costs, and address health care inequities,” said Rebecca G. Mishuris, MD, MPH, an assistant professor of medicine at Boston University School of Medicine and Chief Medical Information Officer of the Boston Medical Center Health System in Massachusetts. “This, of course, will only be realized if we can address equity in engagement with telehealth, and fully incorporate it into a holistic care delivery model that employs both virtual and in-person care.”

Some of the numbers…

At her institution, which is a safety net hospital, 21% of Black/African American patients, 20% of Hispanic/Latino patients, and 22% of White patients reported lacking access to a connected device with a camera or microphone. The study on telehealth disparities, published in the Journal of General Internal Medicine, also showed that 67% of White patients opted to schedule their telehealth visits by video compared with only 60% of Black and Latino patients.

US House Lawmakers Urge Biden Administration to Co-Locate Broadband and EV Charging Infrastructure

Benton Institute for Broadband & Society report..

Reps Anna G Eshoo (D-CA) and Doris Matsui (D-CA) led a letter to Secretary Pete Buttigieg, Secretary Jennifer Granholm, and Assistant Secretary of Commerce for Communications and Information at the National Telecommunications and Information (NTIA) Alan Davidson, urging them to use funding from the Infrastructure Investment and Jobs Act (IIJA) to build out broadband and electric vehicle charging infrastructure simultaneously.

The letter beings

The Infrastructure Investment and Jobs Act (IIJA) makes transformative investments in electric vehicle (EV) charging infrastructure and will help meet the Administration’s critical goal of 500,000 chargers by 2030 to ensure that EVs are accessible to all Americans. As federal agencies, states, and relevant stakeholders develop plans for a robust electric vehicle (EV) charging network across the country, we urge you to consider the connectivity requirements for EV supply equipment (EVSE) as well as the benefits of co-locating EVSE with infrastructure that can also be utilized to deploy broadband.

EV needs broadband and unserved areas are unable to adopt EV…

EV charging access has long been lacking in underserved communities. In 2019, the Department of Energy (DOE) found that 80 percent of EV owners charge in their own homes. Although home chargers are the most used type of chargers in EV adoption, apartment residents are less
likely to have access to at-home chargers. This disparity poses a particular challenge to lower income households and communities of color, who are more likely to live in multi-unit housing.
Similar challenges exist in rural areas, where limited electric distribution exacerbates range anxiety, the concern that vehicles will not be able to travel the distance needed. IIJA addresses these equity concerns by including $2.5 billion to support, among other things, rural charging
and increase EV charging access in disadvantaged communities. Additionally, IIJA directs $5 billion to the National Electric Vehicle Infrastructure (NEVI) Formula Program, resulting in $7.5 billion to build a national electric vehicle charging network.

Gaining access to EV, is one more reason to invest in broadband for all…

Digital equity disparities exist in areas where access to broadband is non-existent or unaffordable and disproportionately affects rural areas and communities of color. A Pew Research Center report showed that 34 percent of Black households and 39 percent of Latino households do not have wired broadband connection. In addition to this, the Census Bureau found that 33 percent of
Native Americans lack a broadband subscription, and 47 percent of those living on tribal lands lack broadband availability altogether. The IIJA acknowledged these disparities and provided $65 billion for broadband expansion, including grants for internet service expansion in unserved and underserved areas.
In light of the national electric vehicle charging network’s connectivity requirements, the persistent digital divide, and EV charging infrastructure disparities across the nation, we encourage you to coordinate IIJA broadband and EV charging infrastructure efforts to encourage co-location of EVSE with telecommunications infrastructure when and where appropriate. The IIJA also included strong prevailing wage protections and preferences to ensure federal funding supports high-skilled, well-paying jobs. We urge you to include and build upon these bedrock protections during deployment to maximize meaningful opportunities for American workers.
This approach can address multiple national priorities simultaneously and avoid duplicative efforts, maximizing IIJA’s wide-reaching equity mission.

Telehealth visits a boon to vets with opioid addiction

It’s hard to compare the last two years with anything before, given the impact of COVID but even given that difference (or maybe because of it) the stats on veterans in recovery and their use of technology. Southern Minn reports

There are many obstacles to opioid addiction treatment, but a new study shows one that one outgrowth of the COVID pandemic — telehealth — is enabling more U.S. veterans to get help.

Researchers examined care given to vets before and after a transition to telehealth visits in early 2020 for treatment of their opioid use disorder. Telehealth for patients receiving the prescription drug buphrenorphine to treat opioid dependence was relatively new in the Veterans Affairs health system before the pandemic, said lead author Dr. Allison Lin.

“The rapid switch to virtual visits for most patients kept people from dropping out of care, and telephone visits [also] played a key role,” said Lin, an addiction psychiatrist at the Ann Arbor VA in Michigan and investigator at the VA Center for Clinical Management Research.

In 2020, phone appointments significantly outnumbered video and in-person visits, the study found. Even in early 2021, phone visits made up 50% of monthly visits for vets using buprenorphine; video visits, 32%; and in-person care, 17%.

Compared to March 2019, on a monthly basis there was a 14% increase in number of vets receiving buphrenorphine treatment in February of last year. Over that same period, 6% fewer vets overall received any kind of addiction treatment.

Governor Walz’s 10-year Economic Expansion Plan includes broadband

Yesterday Governor Walz reported

Governor Tim Walz today announced a ten-year economic expansion plan at Wyoming Machine in Stacy, Minnesota. The Governor’s Council on Economic Expansion today released the 28-page report, titled “Minnesota’s Moment: A Roadmap for Economic Expansion,” which offers long-term steps to continue improving Minnesota’s economy.

One of the Actionable strategies is broadband…

Achieve equitable access to affordable broadband Internet

Here’s more info…

Achieve equitable access to affordable broadband Internet
Ensure every child has access to the Internet, appropriate hardware, training and online learning.
Provide affordable access to broadband Internet, appropriate hardware, and training for every person in Minnesota to expand digital equity and access to government services, health care, jobs, community resources, and social connection.
Drive economic competitiveness for Minnesota and enable communities throughout the State to attract and retain residents and businesses by providing affordable broadband access.

And

COMMIT TO INFRASTRUCTURE – IF MINNESOTA’S COMMITMENTS TO INFRASTRUCTURE ARE SUCCESSFUL, IN 10 YEARS WE WILL SEE:
All Minnesota businesses and households have access to high-speed broadband Internet
Increased home ownership, particularly by those who have historically faced disparity gaps
Decrease the percentage of Minnesotans who are cost-burdened with their housing
Minnesota nationally recognized as a transportation leader that supports the workforce

 

Research shows telehealth helps with prenatal and maternal care

The Grand Rapids Herald (via HealthDay News) reports

Researchers from Oregon Health & Science University reviewed 28 randomized clinical trials and 14 observational studies that included more than 44,000 women. The goal was to determine the effectiveness and any harms of telehealth strategies for maternal health care.

Many of the telehealth strategies included were used to treat postpartum depression or to monitor diabetes or high blood pressure during pregnancy. They also served as an alternative to general maternity care for low-risk pregnancies.

Researchers found these appointments resulted in mostly similar, or sometimes better, outcomes compared with in-person care.

The authors said this may mean that telehealth can be a supplement to usual care for postpartum depression. Telehealth interventions were more likely to improve mood symptoms in the short term compared to in-person care alone, they said, though the effects might not be sustained.

What a gift to not have to go into the doctor’s office for every prenatal visit! Less time off work, or for those of us with a few kids, less taking time off work to bundle up a baby for a routine visit to check out the baby-to-be. And that’s coming from someone with only a 10 minute drive to the doctor’s office. The caveat of course is that sufficient broadband is required.

The Roadmap to Telehealth Efficacy – broadband is essential to good health

It was amazing, and lifesaving, to see how quickly healthcare could move online during the pandemic. Healthcare facilities stepped up their game by bringing in the technology, patients stepped by learning how to use it and government stepped up by relaxing rules on reimbursement and licensure. To keep up the momentum we must continue to have engagement from all three players – and the one that seems most precarious is the relaxed rules.

The folks at Brookings recognized this and came up with a report that makes recommendations to help continue use and growth of telehealth…

  1. Federal and state governments must continue telehealth availability and use in a post-pandemic environment through codifying its use, especially in legislation.
  2. Modality neutrality must become a standard practice to adequately address digital disparities, and ensure full use of remote health care.
  3. The U.S. must adopt a federal privacy standard to ensure patient/ provider confidentiality and reduce risks to data
  4. The larger health care community must understand that they, too, are part of efforts to close the national digital divide through training, device availabilities, and online consumer engagement.
  5. States and localities must prioritize telehealth in their broadband plan and include local stakeholders.
  6. Telehealth should be incorporated in value-based payment initiatives.
  7. The incorporation of AI into telehealth must prioritize equity and fairness.

I think it’s helpful for those of us outside of healthcare and/or policy field to see all that is required to make or sustain such a social shift in how we do things. But it’s really the fourth and fifth points that will relate to most readers. Access to healthcare is a compelling reason to strive for better broadband, especially in areas where physical healthcare facilities are not nearby. Remember to invite healthcare folks to your broadband planning meetings and remember to include telehealth training into your digital equity efforts.