Mayo Clinic implements telehealth approach for neonatologists

Healthcare IT News reports, starting with the stats…

The new technology connects on the first attempt 96% of the time, compared with 73% for the previous telemedicine carts; with enhanced monitoring and support, tele-neonatology availability is 99%.

They began looking at telehealth approaches for neonatologists in 6 years ago. Here’s how it works…

In October 2016, Mayo Clinic’s tele-neonatology program transitioned from a wired telemedicine cart with hardware CODEC to a proactively monitored, fully supported wireless telemedicine product from vendor InTouch Health.

Care teams in the community hospitals activate tele-neonatology when there is a high-risk delivery or a newborn that requires advanced resuscitation. Providers at the community hospital place the wireless telemedicine device at the newborn’s bedside and call Mayo’s Admission and Transfer Center to request a tele-neonatology consult.

A Mayo Clinic neonatologist then establishes a synchronous, audio/video connection with the care team via the telemedicine device in the room. If the newborn requires transfer to Mayo Clinic’s neonatal intensive care unit (NICU), the neonatologist can dispatch the transport team to retrieve the patient as part of the tele-neonatology workflow.

They compared two solutions; the article details the results. They also posted some lessons learned…

“The focus of Mayo Clinic’s tele-neonatology program has always been the needs of our neonatal patients, whether they are located in Mayo Clinic Rochester or elsewhere in our region,” Fang said. “By leading with patient care and identifying unmet needs of patients or care teams, organizations can design telemedicine programs that are impactful, effective and highly utilized.”

When developing a tele-neonatology program, the multi-specialty team must consider many factors including service activation and workflow, staff education and training, team building and communication – and the telemedicine technology itself, she advised.

“Our recently published study (McCauley et al, Telemed and e-Health, 2019) focuses on one of these domains, the telemedicine technology,” she said. “We demonstrated that the ITH Lite improved audio quality and ability to connect on first attempt when compared with a wired telemedicine cart. Organizations should consider the reliability of connection, audio/video quality, and fit within the care environment when selecting a technology for their tele-neonatology program.”

In addition, proactive monitoring is broader than hardware and network monitoring, she cautioned. In this study, incidents were not only identified by vendor monitoring of the devices but also during care team and physician training, tele-neonatology simulation sessions, and physician on-call preparation activities.

“When developing a tele-neonatology program,” Fang concluded, “organizations should consider comprehensive support models for incident management and tracking.”

Broadband Imperative III Driving Connectivity, Access and Student Success – Recommendations and MN Take

State Educational Technology Directors Association (SETDA) just released the a report on broadband access and education, Broadband Imperative III Driving Connectivity, Access and Student Success. Minnesota is a featured case study,

A look at State support…

From a state level, agencies such as the Department of Employment and Economic Development (DEED) and the Minnesota Department of Education (MDE) provide funding through grant opportunities and aid programs to help communities, schools, and public libraries achieve high speed broadband access. The Minnesota Office of Enterprise Technology (MnIT) provides a backbone network (leased, not state owned) throughout the state to deliver connectivity to cities, counties, public schools and libraries in various areas of Minnesota.

State Funding…

Minnesota provides state funding directly to the district for external broadband connections and directly to the regional networks. Through regional partnerships, the median cost of broadband (per mbps) in Minnesota schools has dropped 84% from $15 in 2015 to $2.35 in 2018. While cost has decreased, the amount of bandwidth necessary for students to participate in digital learning has increased. In the same period of time, the median bandwidth speeds available on a per student basis has increased almost four fold from 226kbps to 890kbps. Minnesota currently provides limited state funding for connectivity on buses and previously provided one-time grants that could be used to obtain hotspot devices for students to use off campus. Minnesota does not provide funding for internal wireless connections.

Regional support…

Minnesota provides education broadband connectivity through 19 regional networks. … Most school districts rely on the federal E-rate program to afford high speed broadband, so they use the corresponding competitive bid process either independently to choose a regional network or the regional network completes a competitive bid process through E-rate for the regional broadband network as a wide area network for all members. The networks are coordinated by a cooperative or nonprofit education agency that provides services to the K-12 education system. Minnesota estimates that 50% – 74% of districts participate in a regional network.

They highlight programs and projects such as Southwest West Central Service Cooperative (SWWC)’s recent upgrade from a microwave network to fiber. They also look at remote music classes through MacPhail Center for Music and of course they mention redesigned Minnesota snow days. And they talk about off campus access…

In Minnesota, other state agencies, libraries, community-based groups and the state broadband commission work together to coordinate efforts to support student access to off campus connectivity. The state is promoting strategies, both formally and informally, for access to affordable out-of-school broadband for students, especially in low-income and rural areas through legislated funding; promotion of discount/ free options; community partnerships; connecting anchor institutions; and Wi-Fi on buses. Off campus access strategies are driven by availability and affordability in rural areas; minimum broadband standards, such as speed, safety and security, as well as limited service options for consumers. Specifically, through efforts by the Governor’s Task Force on Broadband and the Office of Broadband development, statutory goals were put in place calling for all homes and businesses to have access to broadband service of at least 25 Mbps download and 3 Mbps upload by 2022 and that by 2026 all homes and businesses would have access to broadband service of at least 100 Mbps download and 20Mbps upload from at least one provider. To help incentivize the deployment of broadband in rural areas, the state funded grant programs and projects that offer new or upgraded broadband service to unserved and underserved areas of the state. Grant programs have totaled $85.6 million to date and $500,000 was awarded to provide schools with mobile hotspots available to students without adequate broadband access at home. The grant programs were administered by the Office of Broadband Development and funding for the programs has been consistently supported by the Governor’s Task Force on Broadband. Grants have also been awarded to provide schools with mobile hotspots for students without adequate broadband access at home.

And future plans…

Minnesota’s regional broadband networks will continue to seek cost-effective broadband solutions for all Minnesota school districts by leveraging state and federal funding initiatives and local partnerships with an eye toward always providing the bandwidth that districts need to fully participate in digital learning and utilize digital resources. Additionally, the regional networks will continue to expand enterprise level services designed to share resources that are expensive for smaller, often rural, districts to afford on their own. Services that will improve network and data security, provide access to online resources, bring educational opportunities directly to the schools and improve administrative procedures within districts.

The report also include a series of recommendations…

Technology and Pedagogical Approaches

Districts and schools are in different stages when considering access to and the utilization of digital tools. The integration of technology for learning is a unique journey that each school or district may embark upon differently. Leaders must focus on academic goals and leverage technology to support student learning experiences in preparation for college and/or careers in the digital age.

Digital Access and Equity

Addressing digital equity for all students continues to be a challenge and stakeholders must ensure that we consider equitable student access to broadband and devices both on and off campus. Every child, regardless of background, race or economic status deserves equitable access to personalized, student-centered learning experiences to prepare for life and work in the global economy.

Planning Infrastructure for the Future

Schools and districts should strategically plan for reliable, high speed networks to support sustained, seamless access to the internet for the implementation of administrative tools, the Internet of things and teaching and learning activities, without disruption. Districts should consider the recommended peak utilization bandwidth capacity goals and WAN implementation considerations as a guide and then plan according to their current and future needs as they move to teaching and learning environments that mimic the corporate structure.

Building Networks for the Future

In order to create sustainable, robust and reliable networks, administrators and technology leaders must look at the level of digital learning implementation and the administrative and security services relying on the network. Additionally, education organizations must implement the most effective security practices to protect their communities.

Policies and Funding Federal: The federal government should continue to expand federal funding options to support:

(a) state, regional and district broadband networks,
(b) districts and schools increasing bandwidth capacity to and throughout each campus, (c) communities in providing access points at anchor institutions, such as libraries and community centers. State: As schools increase digital learning opportunities, states need to demonstrate leadership to support high-speed broadband connectivity by leveraging policies, networks and purchasing options to support increased broadband access in schools.

Broadband for America’s Future: A Vision for the 2020s outlines a policy plan for local, state and national audiences

The Benton Institute for Broadband & Society released a new report; last week I looked at mentions of Minnesota today I thought I’d look more broadly at the report. They define three main benefits better broadband can deliver…

  • Growing the American Economy. High-Performance Broadband transforms industries that are basic to everyday life, positively impacting agriculture, education, healthcare, energy, and more.
  • Empowering Workers. High-Performance Broadband advances skills training to boost individual opportunity, helping to overcome income inequality and economic frustration.
  • Strengthening Communities. High-Performance Broadband spurs economic growth and jobs. It can enable civic participation. It can improve the health, education. and learning of community members.

Then they look at a four-prong approach to making that happen. Here’s an outline of topics in the report based on the four segments:

Advancing Broadband Deployment

  • Map Broadband Oases and Deserts
  • Deploy High-Performance Broadband
  • Reach Unserved Areas (and Reject the Claim of “Overbuilding”)
  • Deploy High-Performance Broadband on Tribal Lands
  • Employ Reverse Auctions to Stretch Federal Dollars
  • Establish Eligibility for Reverse-Auction Participation
  • Establish Requirements for Funded Deployment
  • Increase the Effectiveness of Federal Efforts
  • Support State Strategies Targeted for Specific State Circumstances and Needs

Promoting Broadband Competition

  • Promote Broadband Competition at the Local Level
  • Enact Stronger Federal Policies to Spur Broadband Competition
  • Execute Additional Pro-Competition Recommendations in Other Parts of This Report

Ensuring Affordability and Adoption

  • Create an Affordability Agenda
  • Support Digital Skills
  • Incorporate Digital Skills Training in Regional Economic-Growth Strategies

Supporting Community Anchor Institutions

  • Governments should establish connectivity goals fit for the rising demands of the next decade, including periodically re-examining the current goals set by the FCC for federally funded connectivity to schools and libraries and establishing connectivity goals for other community anchor institutions.
  • Governments should support and promote competition to drive better broadband at lower prices for community anchor institutions.
  • The administration of broadband programs supporting community anchor institutions must be transparent, rely on competitive outcomes, and provide reasoned (and thus reviewable) analysis for administrative decisions.
  • Federal and state programs should empower community members—particularly K-12 students—to access community anchor institution broadband and crucial applications ubiquitously.
  • Governmental support for High-Performance Broadband deployment to community anchor institutions should leverage those networks to spur competition and greater connectivity for nearby residents.
  • Spectrum policy should allow community anchor institutions to be full or even favored participants in shared and tiered access.
  • State and local governments should facilitate comprehensive broadband strategies, including encouraging the creation and growth of state research and education networks and bringing institutions together to learn from one another.

The report is filled with persuasive stats and stories. In fact, if you were looking to build awareness of broadband, you could do worse that Tweet a stat a day from this report!

Mentions of Minnesota in Broadband for America’s Future: A vision for the 2020s

The Benton Institute for Broadband & Society released a new report than in many ways reads like a latest version of a US broadband plan – or more like an invitation to create a new broadband plan. It’s very detailed and (unabashedly) looks at the positive impact of broadband. I thought I’d write about the report at least twice because there’s so much going on. Today I thought I’d pull out the parts that mention Minnesota.

Blandin gets a nod in the first new pages…

Leadership does not, of course, come only from government, but from community-focused organizations as well. For example, the Blandin Foundation focuses on strengthening rural Minnesota, including by supporting and measuring the impact of broadband in rural communities—measurements that found concrete economic benefits such as income growth resulting from broadband deployment.1

And then in a profile later in the report…

Building and revitalizing strong communities is hard work. It takes leadership, reaching across boundaries, and building lasting connections. For over 16 years, the Blandin Foundation has included broadband deployment and adoption in its efforts to build healthy and vibrant rural communities in Minnesota.

Blandin has been a trusted partner with, and advocate for, rural Minnesota since 1941. Drawing from this deep history of relationships, Blandin has partnered with dozens of rural communities and funded hundreds of projects to enhance quality of life and place.

In one of Blandin’s biggest and most impactful efforts, it implemented the Minnesota Intelligent Rural Communities (MIRC) project with a combination of $4.8 million in funds from the National Telecommunications and Information Administration’s (NTIA) Broadband Technology Opportunities Program (BTOP) and $1.5 million in matching funds from project partners.

MIRC was a three-year project (2010–13); a multi-sector, comprehensive approach to promote broadband adoption that targeted un- and underemployed workers, non-adopters, low-income residents, small businesses, local governments, and critical services providers.

Eleven demonstration communities brought MIRC to every corner of rural Minnesota. This cross section of cities, towns, counties, and multi-county regions—with a total population of 250,000 people and population density ranging from 4 to 1,700 people per square mile— gave the project the opportunity to test the impact of education, training, and outreach efforts within communities of varying populations, size, and social and economic profiles. Further, the communities had a wide variety of telecommunications infrastructure and services, ranging from municipally owned and operated networks to duopoly-served markets to legacy providers.

The project used a community and economic development framework, called Intelligent Communities, which establish es five core community characteristics (broadband connectivity, digital inclusion, knowledge workforce, innovation, and marketing and advocacy).

MIRC set target outcomes that could be measured and monitored—all of which were accomplished or exceeded. In the past six years, Blandin’s Broadband Communities (BBC) program has applied what it learned during the MIRC program to its two-year partnerships with other rural Minnesota communities:

Communities know best and need to engage their citizens directly in articulating and reaching broadband adoption and utilization goals.

Local leadership matters, and leaders need to be trained to frame issues, build and sustain relationships, and mobilize people to build a community’s capacity to achieve its broadband goals.

Intra-community, personalized outreach works for technologically challenged small businesses and for historically marginalized populations.

Peers make great teachers and are a popular, low-cost, and easily sustainable resource to build a community’s technological savvy.

Cross-community communication is key to spurring and sustaining energy and excitement for community broadband projects.

Encourage a next generation of young leaders who can bring energy and sustainability to any community initiative by serving as co-trainers, technology mentors, and partners in computer refurbishment projects—and can use video and other social media to promote their communities.

Connect the economic dots. The “whole picture” Intelligent Community framework for community and economic development used in MIRC can help community leaders see how workforce, infrastructure, inclusivity, innovation, and marketing/ advocacy are mutually interdependent aspects of community vitality.

Have patience. This work takes time. Look for and celebrate early and easy “wins” along the way, but think long-term and build capacity and energy for the long haul. Money and other resources follow vision and commitment.

Then throughout the report, they mention part or aspects of Minnesota’s state speed goals and related legislation…

  • By contrast, Minnesota defines “underserved” as any place where “households or businesses lack access to wireline broadband service at speeds of at least 100 megabits per second download and at least 20 megabits per second upload.
  • Thus, recent legislation proposals and state programs, like Minnesota’s, target funding to any area that lacks at least 100 Mbps download (the upload numbers vary). That is a good beginning, in part because networks that provide those kinds of speeds (and associated features like low latency and capacious usage) can typically be upgraded at relatively modest costs as demand requires.
  • At least twenty states—including Colorado, North Carolina, Virginia, Maine, Michigan, Minnesota, and Wisconsin—have statewide broadband strategies with dedicated funding to promote deployments.269 Forty-four states have broadband offices, task forces, or legislative committees responsible for facilitating broadband deployments.
  • Minnesota has lodged its effort in its Department of Employment and Economic Development, so the state’s program expressly considers the “likely economic impact” of the project alongside evidence of community 38 Chapter 2: Deployment of High-Performance Broadband Networks to Unserved Areas support.271 Minnesota funds deployment in both unserved and underserved locations, and its funds can be used for both last-mile and middle-mile construction.
  • To date, Minnesota has funded broadband service to more than 34,000 previously unserved households, 5,200 businesses, and 300 community institutions,274 and 100/20 Mbps service is now available to nearly 75 percent of households.275 Minnesota’s efforts also illustrate the importance of broadband to advancing local economic goals.276 For example, rural tourist destinations in Minnesota have struggled to meet guests’ needs—and even process credit card purchases—because of slow internet connections.277 In Cook County, the state’s second largest county by square miles and a place that needs better broadband to satisfy the demands of tourists, the Arrowhead Electric Cooperative built a network with federal and local funding that provides roughly 95 percent of the county with access to internet with speeds of at least 100/20 Mbps over a fiber-based network.
  • Minnesota’s Broadband Task Force Report recommends that the state prioritize funding its regional library systems so that libraries can benefit from “economies of scale providing greater effectiveness, improved quality and access to more resources.”
  • The Minnesota Broadband Infrastructure Plan began in 2008 and is reassessed on an annual basis by the legislature as it considers adjustments to the elements codified into law.

Tomorrow (or maybe Monday) I look beyond the Minnesota scope – but it’s always nice to see how Minnesota plays outside state boundaries. And I think we played well.

Broadband use with immigrants is increasing

NTIA just released a report on American’s Hispanic and immigrant use of broadband. The good news is that usage is increasing – as the chart below shows…

But I found at least if not more interesting is that use with immigrant populations is increasing…

In a previous analysis of the challenges faced by Hispanic Americans, NTIA found that language barriers and immigration patterns were associated with lower rates of Internet use. But while immigrants continued to be less likely to go online than their U.S.-born peers in 2017, the differences appear to be shrinking. Internet use among non-U.S. citizens jumped by 11 percentage points between 2013 and 2017, from 62 percent to 73 percent, and adoption among naturalized citizens climbed from 68 percent to 75 percent during this period.

And use with second generation is even better…

New NTIA analysis shows that persons born in the U.S. to immigrant parents were nearly as likely to use the Internet as those with two U.S.-born parents. While 74 percent of immigrants used the Internet in 2017, 77 percent of U.S.-born persons with at least one immigrant parent did so, compared with 78 percent of those born to two U.S.-born parents. The similarity in Internet usage rates between U.S.-born persons with immigrant parents and those with U.S.-born parents is consistent across age groups (see Figure 2).

I understand the language barrier and for many immigrants cost is an issue. But the benefits of broadband must be even greater when it’s likely a bridge back to your home and family. And of course with broadband use comes benefits in terms of remote access to education, jobs and information. I’m glad to see the rates rising.

New interactive broadband maps include price down to census block

Big news

BroadbandNow, the web site that helps consumers comparison shop for broadband service, has unveiled a new National Broadband Map that includes, for the first time, the price of service to the zip code and census block.

“We believe that affordability and access to low prices is under-covered as a topic in the discussion of digital inclusion and wanted to change that.

For where broadband is available it relies on the FCC form 477 data from carriers that has come under criticism, including by BroadbandNow, but the group says over 100 ISPs have updated that info.

Other features:

“Includes pricing: our map integrates our propriety and constantly updated pricing data from over 2,000 ISPs.

The map is worth checking out. You can filter by mode of broadband and find out provider count, minimum and maximum speed and minimum price reported. Here’s a screenshot below:

Computer and Tech Skills Top Rural Americans’ List of Training Needed to Find a Better Job

From the Internet Innovation Alliance

This statistic shows rural Americans’ views on which skills or trainings are needed to keep or find a better job in their community in 2018. During the survey, 25 percent of respondents said that they believe they need computer and technical skills trainings to keep or find a better job in their community.