The evolution continues with new guidelines from NIH for submitting proposals.

– via Medical Writing, Editing and Grantmanship accompanied by some interesting comments.

Many TFHHC applications require a broadband internet connection.

According to an article in the LA Times, Vermont ranks 45th among 50 states and two territories, with an average download speed of 3.32 megabits. Neighbor New Hampshire ranked 8th with an average download speed of 7.17 megabits.

Using data gathered from Speed Matters, a site that promotes greater Internet speeds, the Communications Workers of America compiled a list of broadband speeds in U.S. states and territories, and came up with the average speed for the nation — about 5 megabits per second. That’s a quarter of South Korea’s 20.4 Mbps, and about a third of Japan’s 15.8 Mbps.

The article states that the survey was not scientific. This is a gross understatement, as certainly the data can be skewed depending on where the readings are taken within a state and the number of samples. Large swaths of Vermont have no access to broadband connections, two years after our governor declared us an “e-State”. (!)

They survey only reports download speeds. Since most internet connections are “asymmetrical” upload speeds are a fraction of the download speeds. For high-bandwidth applications like videoconferencing, cheap DSL and cable connections are inadequate… and that suits the vendors just fine.

My speeds are: 12762 down and 1265 up at 9:44 EST on a Wednsday morning with a Comcast “business” account. Asymmetrical at a 10:1 ratio. Fortunately, our video application works at 384Kb.

It would be easy to dismiss the survey as junk. But the larger points are:

• Broadband is the infrastructure of our time, much as rural electrification, copper telephone lines, and the interstate highway system were in the 1930’s, 1940’s and 1960’s. We haven’t had a national commitment for a “transformational” infrastructure since the middle of the last century.
• Despite the fractional cost of broadband, compared to the previous infrastructures, (the poles are already in place!) symmetric, high-speed broadband to homes isn’t happening out in the boondocks, and the prospect of fully wiring rural states like Vermont is years away. Compare the cost of a mile of fiber-optic cable with the cost of a mile of interstate highway.
• For all the breast-beating about great the U.S. is, we are going to get our clocked cleaned in the technological revolution of telecommunications. (We’re already getting hosed on renewable energy and battery technologies ).

The following notes are cribbed from techfornonprofits.com from over a year ago, but summarize opportunities to enhance home health care.

I attended the ATA annual meeting in Seattle a couple of weeks ago. This is a roughly two-day affair with pre and post sessions available for those who wish to take full or half-day seminars. The ATA is one of the largest associations for implementers and practitioners of telemedicine in the U.S. There was a good-sized trade show with impressive exhibits by well-known companies like Intel, Polycom and Tandberg as well as dozens of smaller companies. A portion of the show floor was given over to about eight enormous mobile clinics, large buses or recreational vehicles transformed into mobile hospital or clinic facilities.
The meeting was divided into several different tracks. These included:

• Emergency and Remote Telemedicine
• Patient sensors and home telemonitoring
• Videoconferencing
• Business models, management and finance

This was my first ATA meeting, and the first time I had been in Seattle.
The format for most presentations was a fifteen minute lecture followed by a few questions. Presentations fell in to the tracks as described above. I was interested in particular in hardware, including video and sensors. While there were a couple of presentations that described work similar to ours, nobody described a program delivered over multi-point videoconferencing. Some random notes:

• Every person in the United Kingdom is registered with a family doctor
• Virtually all primary care in the UK is computerized
• When an entity (like the National Health Service in Britain, or Kaiser Permanente in California) is both the payer and the health-care provider barriers to automation and improved productivity via electronic medical records and telemedicine are reduced. Much of the lag in the U.S. of implementing the electronic medical record is due to the lack of clarity over who benefits, and who pays for its implementation. When these are not the same entity, there is conflict.
• The Continua Health Alliance is an industry group implementing interface standards for sensor data transmission using exisiting hardware; Bluetooth, USB and Zigbee.
• Vital sign sensors are a big deal. There was a great deal of discussion of patient self-administered readings of weight, glucose levels, and blood pressure which are sent via a wireless connection to a hub connected to a telephone.
• Some patients may have a different perception of “good health”, than might otherwise be expected. Some patients described themselves to be in good health, although they are on oxygen, confined to a scooter or wheel chair, and have had a third heart bypass operation.
• In focus group studies patients said they liked being able to take readings at home. It allowed for more privacy, and allowed the patient to be involved in their own care.
• Things that people didn’t like about home health-care equipment; having to move it around, “smells like a hospital”, disruptive of routine.
• The “smart home” for assisted living could involve sensors and motion detectors . Think of smoke detectors, which are an example of a sensor.
• All medical students have PDAs or smart phones. When they get out of medical school they are going to be expecting digital connections. They don’t expect to see patients for 12 hours a day. There may be a whole new group of physicians in areas like correctional telemedicine.
• We don’t have “real-time” now. I have to walk across the street to get my meds, down the hall to get blood drawn. Patients wearing sensors are already much faster (whether tele or not).
• The American crisis in health care is THE opportunity for Telemedicine.
• Find a forward-thinking governor in a small state that would be willing to grasp the opportunity with long-term care and telehealth, Opportunities under medicaid “308″? Pennsyvania “ERA” program. Remote monitoring and chronic disease management Several very large self-insured employers are taking this on.

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