VA wants Telemedicine authority to improve health care for rural veterans

IT World reports…

Officials from the VA recently made their way to Capitol Hill to appeal for legislation that would grant the agency greater flexibility in providing remote health services to the military community. In particular, the VA is putting a “special emphasis” on improving the delivery of health services for veterans in rural and “underserved” areas, according to Dr. Kevin Galpin, executive director of telehealth services at the Veterans Health Administration.

They are looking for a solution that could open a door to similar solutions where policy is hindering technology use…

Galpin’s primary request is relatively straightforward. He is asking Congress to expressly affirm that VA providers are authorized to deliver telehealth services across state lines and to patients in their homes.

“This authority will remove barriers that currently exist between a national VA clinical expert and a veteran that needs their service,” he said.

They have had success with telemedicine and want to continue to grow…

The VA has three broad categories of telehealth services, comprised of clinical telehealth, home telehealth, and “store and forward” services, where a device captures an image and relays it along to be examined by a specialist at a later time.

The VA offers telehealth services in more than 50 clinical specialties. The VA reports that more than 307,000 veterans received care through a clinical telehealth encounter last year, and, at present, more than 87,000 are using home telehealth services.

In an interesting tangent, the Minnesota House is looking at the definition of telemedicine

HF1314/ SF1353*, sponsored by Rep. Matt Dean (R-Dellwood) and Sen. Julie Rosen (R-Vernon Center), would cover professional standards both regarding practice and conduct and services that can be provided via telemedicine including assessment, diagnosis, treatment, education and care management.

The bill would also clarify that “telemedicine” refers to real-time, two-way interactive audio, visual and audio-visual communications — like secure video conferencing, said Rep. Nick Zerwas (R-Elk River).

A telephone conversation, email or fax between licensed health care providers would not count as telemedicine consultation or service.

The Minnesota definition seems more limiting that the federal as I’m not sure where the VA’s idea of home telehealth and store and forward fit into the local version of telehealth as video conference. And it will be interesting to see how such differences get ironed out especially since one of the things the VA is requesting is authorization to deliver telehealth service across state lines.

MN Broadband Task Force April 2017: Making the business case for broadband

The Task Force heard from folks in the field who slice and dice the numbers to help people understand what it will take to deploy broadband in rural areas. They heard from Mark Mrla of Finley Engineering about his work on broadband feasibility studies. When ordered by a rural community, many feasibility studies in Minnesota have become like a work plan. Communities use it to approach providers (directly or through and RFP) and many have then gone on to seek (and get) state broadband funding. ComQuest spoke about their broadband modeling tool that helps communities and providers build scenarios for business case development. They can alter variables to predict outcomes. Dusty Johnson from Vantage Point talked about the economic impact of the rural broadband industry on rural and urban areas.

They also heard from Minnesota economic developers (Cheryal Hills, Executive Director, Region 5 Development Commission, Sheila Haverkamp, Executive Director, Brainerd Lakes Area Economic Development Corporation and Kristi Westbrock, COO, Consolidated Telecommunications Co.). Kristi works with the local CTC but their surveys on the impact of their network indicates that she’s an economic developer too.

They also got a legislative update.

It was an interesting discussion. Continue reading

Akamai Q4 (2016) broadband report is out – MN ranks 25-29 depending on the category

The latest Akamai Report is out Q4 (2016). They measure worldwide broadband adoption and speeds. Turns out Minnesota is pretty middle of the pack. Really Minnesota doesn’t even rank well enough to make the report (they only list “top 10) but the folks at Akamai are kind enough to send me our stats.

I’ve included below charts from the report – followed by Minnesota stats…

Average connection speed:

We rank #26 with an average connection speed of 16.2 Mbps – that’s a slight increase over Q3 (1.5 percent) but a nice increase from 2015 (8.5 percent).

Average peak connection speed:

We rank #27 with an average peak connection speed of 76.3 Mbps – that’s an increase over Q3 (3.5 percent) but a very nice increase from 2015 (24 percent).

4 Mbps broadband adoption:

We rank 29 with 88 percent having access. That’s an increase of 1.1 percent from Q3 and 5.1 percent from 2015.

10 Mbps broadband adoption:

We rank 26 with 60 percent having access. That’s an increase of 6.5 percent from Q3 and 16 percent from 2015.

15 Mbps broadband adoption:

We rank 25 with 39 percent having access. That’s an increase of 5.2 percent from Q3 and 20 percent from 2015.

25 Mbps broadband adoption:

We rank 26 with 14 percent having access. That’s an decrease of .1 percent from Q3 and an increase of 17 percent from 2015.

There’s a slight dip in growth in the 25 Mbps category. We weren’t the only state to see a decrease there and the decrease is slight (.1 percent) so that isn’t too concerning. What is concerning is the stronghold we have on middle of the pack standing!

It is disheartening to rank #27 for peak connection speed with 76.3 Mbps. It’s not great to be #27 – but again more concerning is that while the average peak for the state is 76.3 Mbps 12 percent of the state doesn’t have access to 4 Mbps. That’s quite a digital divide.

Turn snow days into e-learning day? Good idea once everyone has broadband and a computer!

I’m a little slow about posting this suggested bill  – (SF 1241 & HF 1421) to turn snow days into e-learning days. The St Cloud Times gave a nice description…

Minnesota lawmakers are considering legislation that could spell the end for snow days.

A House committee Thursday will discuss a bill that could replace up to five snow days each year with “e-learning days.” Students would get on a laptop or tablet at home and follow along with online lessons on school days that would otherwise have been canceled.

Like a snow day, parents would be alerted to the at-home learning day at least two hours before the start of school and teachers would be available throughout the day to answer students’ questions.

Minnesota lawmakers are considering legislation that could spell the end for snow days.

A House committee Thursday will discuss a bill that could replace up to five snow days each year with “e-learning days.” Students would get on a laptop or tablet at home and follow along with online lessons on school days that would otherwise have been canceled.

Like a snow day, parents would be alerted to the at-home learning day at least two hours before the start of school and teachers would be available throughout the day to answer students’ questions.

Looks like the bill has been referred to another committee (Education Innovation Policy in the House and E-12 Policy in the Senate). I know Red Wing has been successful with this push. It would help keep kids on track and minimize the nightmare of planning for snow days. I have three kids in three schools and each handles differently snow days and making up for or using snow days at the end of the year. It’s a little bit of a parental nightmare – worse for the schools I imagine. But I don’t think this conversation (never mind conversion) can happen until every student in the state has access to adequate broadband and a computer or device to use it.

Although cards on the table – I grew up in Minnesota. I remember the pure joy of waking up to snow, listening to WCCO and cheering when my school was called off. And even when it was/is my kids school that’s called off, there’s still a little residual joy in the house.

Winona County Broadband Profile: 81 percent access to 25/3 and 100/20 and grants to help upgrade

In 2014, winona90 percent of Winona County had access to broadband. (Broadband was defined with lower speeds back then.) Today 82 percent of the county has access to broadband speeds of 25/3 (Mbps down/up) and 81 percent has access to the 2026 speed goals of 100/20.

Winona is doing well and they got a recent Border to Border broadband grant to help them do even better…

the county will get $416,000 to continue broadband expansion into areas of Wilson, Homer, Richmond, Pleasant Hill and Wiscoy townships.

The total project cost is estimated to be $868,000, with a match by HBC covering the rest.

The project is expected to reach 111 households, 112 unserved businesses, and two community institutions currently unserved or underserved.

Winona County administrator Ken Fritz said the county would like to continue using the programs if the state continues providing grants.

They had received funding in the past as well…

Last year the county was awarded $314,500 to a project to expand broadband into the Witoka and Wilson areas, with HBC covering the rest of the near $1 million project cost. That project started in spring 2016 and affected an estimated 256 households, 117 businesses, 90 farms, nine commercial and industrial businesses, 18 home-based businesses, a school and other public institutions.

In 2015 the county also received $247,000 for broadband expansion in Elba and Norton townships, including Whitewater State Park. The overall project is estimated to cost nearly $775,000. That project will provide improved internet to an estimated 135 households, 70 businesses, Whitewater State Park, Whitewater Wildlife Management Area, Crystal Springs Fish Hatchery, a school and other public institutions.

Winona has been an involved community. They were a Minnesota Intelligent Rural Community (Blandin MIRC) community where among other projects they worked with Project FINE to provide digital inclusion training in multiple languages. Last summer (2016), Senator Franken’s team held listening session in the area to discuss broadband.

Winona County is also in line to receive $245,212 in CAF 2 funding to upgrade 475 locations. CAF 2 recipients are only required to upgrade to 10/1 access. Many may choose to upgrade to better speeds but there are no requirements.

Numbers:

The Office of Broadband Development released data on broadband covered in fall of 2016, based on information gathered in July 2016. Here’s how they ranked:

  • Percentage served with 25/3 or better: 82.13
  • Percentage served with 100/20 or better: 81.17

ranking-roseau-to-yellow-medicine

Mississippi State University Extension have come up with a ranking system to gauge the digital divide index (DDI) by county. (The lower the number the better – the state average is 40.66.) Here’s how they ranked:

DDI score of 41.93 out of 100.

More info:

I plan to profile each county in Minnesota – tracking broadband access, digital divide and annotated links to news of what’s happening with broadband in the county. I’m keeping it high level because there are 87 counties!

Stearns County Broadband Profile: 87 percent access to 25/3; 38 percent access to 100/20 but grants will help

stearnsIn 2014, 92 percent of Stearns County had access to broadband. (Broadband was defined with lower speeds back then.) Today 87 percent of the county has access to broadband speeds of 25/3 (Mbps down/up) and 38 percent has access to the 2026 speed goals of 100/20.

They are going the wrong direction but State grants will help.

In 2015, the St Cloud Times took a good look at broadband in Stearns County, outing services offered by the local providers. It is informative to look at the range (remember this is from 2015!)…

In the middle of 2014, Midcontinent doubled connection speeds for its customers, partly as a test, Simmons said. Channel-bonding technology allowed the company to change the 30 Mbps service most customers received to 60 Mbps, 50 to 100, and so on.

With a $75 million investment, the company is going to keep increasing speeds. Its Gigabit Initiative will bring 1 Gbps connections to all business and home consumers in the Upper Midwest by sometime in 2017, Simmons said.

Midcontinent uses hybrid fiber-coaxial technology to deliver Internet service.

CenturyLink also uses fiber to deliver service to residential areas and DSL in the home, according to Rachel Woodman, market development manager. The company has almost entirely abandoned copper in favor of fiber, a technology experiencing a CenturyLink “build-up” in the St. Cloud area. Woodman said the majority of Central Minnesota customers have connections of up to 40 Mbps available.

Charter Communications connects customers to the Internet through its coaxial cable lines and in-home modems.

Paul Bunyan Communications announced in late summer it has started construction on a fiber network in the Bemidji area that will bring connections with speeds up to 1 Gbps to customers. Some locations will receive the service this year, with the entire 5,000-square-mile service area being covered in coming years.

Some area companies, such as Skynet Broadband Inc. and CitEscape High Speed Internet, both based in St. Cloud, offer fixed wireless connections, the speeds of which are increasing along with in-ground technologies.

John Townsend, sales and marketing director for SkyNet, said starting now in January, the new SkyNet tower in Waite Park will connect users through a synchronized network that will “blast” signals to and from an exact point located by GPS. …

CitEscape offers residential access with download speeds of 1.5 to 10 Mbps, according to Laura Kangas. She and her husband Albert own and operate Palmer Wireless, the company that put Wi-Fi capabilities on buses in Becker, and they purchased CitEscape this fall.

She said one advantage her company’s wireless service has over mobile broadband through cellular networks or satellites is unlimited data. “Ten gigabytes doesn’t go too far anymore,” she said.

TDS Telecom offers Internet access, management and voice-related services to business customers in St. Cloud and residential users in the surrounding area.

Nextera Communications services businesses in Central Minnesota primarily with a combination of T-1 lines, according to President Greg Arvig, whose relation to the service provider that shares his name is through blood, not business.

Connections range from about 1 Mbps to a couple hundred, he said, with Nextera tailoring speeds to each application.

In 2015, a small portion of Stearns County benefitted from a Border to Border grant

Arvig (Mainstreet Communications LLC), Sauk Lake area. Awarded $536,702 to build broadband infrastructure to serve 217 unserved premises in the Sauk Lake area, which is located primarily in Todd County (with some project area in rural Stearns County) just north of Sauk Centre. This is an unserved area where no wired broadband infrastructure is available. The full project cost is $1.07 million; the remaining $536,703 (50 percent) will be supplied by a private investment made by Arvig.

Good news – they will benefit from two Border to Border grants

Albany Mutual Telephone Association, Big Watab Lake – $726,185. The project will serve 242 unserved households in the Big Watab Lake area in Stearns County. Albany Mutual will improve service for families that need high-speed broadband for school and work. The total eligible project cost is $1.45 million, with a $726,185 local match.

Palmer Wireless, Del Tone Road and St. Cloud Airport – $179,400. This project will serve 14 unserved businesses and 1 unserved community anchor institution on the east side of St. Cloud. Palmer Wireless will make improvements that will upgrade business connectivity in the Highway 10 corridor, increasing business development opportunities and customer access. The total eligible project cost is $460,000, with a $280,600 local match.[Stearns County]

Stearns County is also in line to receive $1,530,252 in CAF 2 funding to upgrade 3883 locations. CAF 2 recipients are only required to upgrade to 10/1 access. Many may choose to upgrade to better speeds but there are no requirements.

Numbers:

The Office of Broadband Development released data on broadband covered in fall of 2016, based on information gathered in July 2016. Here’s how they ranked:

  • Percentage served with 25/3 or better: 87.58
  • Percentage served with 100/20 or better: 38.01

ranking-roseau-to-yellow-medicine

Mississippi State University Extension have come up with a ranking system to gauge the digital divide index (DDI) by county. (The lower the number the better – the state average is 40.66.) Here’s how they ranked:

DDI score of 30.79 out of 100.

More info:

I plan to profile each county in Minnesota – tracking broadband access, digital divide and annotated links to news of what’s happening with broadband in the county. I’m keeping it high level because there are 87 counties!

Marshall County broadband profile: Marshall’s broadband ranks 85 out of 87 but improvements are planned

marshallMarshall County is in bad shape when it comes to broadband coverage. Only 33 percent of the county has access to broadband speeds of 25/3 (Mbps down/up) and only 9 percent has access to speeds of 100/20, which is the Minnesota speed goal for 2016. But they have had some good news.

Although the impact may not be seen in the maps yet, they did get Border to Border funding in 2015

Wikstrom Telephone, Kittson, Marshall, Roseau Broadband Extension. Awarded $425,000 to bring fiber-to-the-home service to 73 unserved and 43 underserved locations in Kittson (15 premises), Marshall (50 premises) and Roseau (51 premises) counties. The total project costs are $943,827; the remaining $518,827 (55 percent local match) will be provided by Wikstrom.

And they recently received funding in the latest round of Border to Border grants – so perhaps we’ll see improvements in the future. Because the grants are required to be scalable to 100/20, they should at least be setting themselves up for greater coverage by the 2026 standards…

Wikstrom Telephone Co. (with Beamco Inc.), Rural Alvarado – $43,481. The project will serve 11 unserved households and 1 unserved business in the Alvarado area, in a remote part of Marshall County. The telephone company and Beamco Inc., a local engineering and manufacturing company, are partnering to improve services in the area.

Marshall County is also in line to receive $454,418 in CAF 2 funding to upgrade 535 locations. CAF 2 recipients are only required to upgrade to 10/1 access. Many may choose to upgrade to better speeds but there are no requirements.

Numbers:

The Office of Broadband Development released data on broadband covered in fall of 2016, based on information gathered in July 2016. Here’s how they ranked:

  • Percentage served with 25/3 or better: 33.49
  • Percentage served with 100/20 or better: 9.20

kan-to-mow

Mississippi State University Extension have come up with a ranking system to gauge the digital divide index (DDI) by county. (The lower the number the better – the state average is 40.66.) Here’s how they ranked:

DDI score of 53.94 out of 100.

More info:

I plan to profile each county in Minnesota – tracking broadband access, digital divide and annotated links to news of what’s happening with broadband in the county. I’m keeping it high level because there are 87 counties!