A couple of weeks ago, Telstra breathlessly announced “the future of medical diagnosis”, namely “haptically-enabled robotics” that mean ultrasound examinations can be conducted remotely, complete with force-feedback so that a sonographer can guide their instrument over a distant body's lumps and bumps.
I've often heard it argued that tele-health's potential to save money by keeping us all out of expensive hospital beds will just about pay for Australia's national broadband network (NBN) by itself. So I asked Telstra how much bandwidth the “future of medical diagnosis” requires.
I was told it uses four or five megabits per second for the video and a little more for data driving the haptics.
Not the minimum 100 megabits per second that critics of the multi-technology-mix being used to construct Australia's national broadband network (NBN) argue will be needed any moment now. Four or five megabits per second.
I've also recently chatted with Doctor Victoria Wade, a senior research fellow at the University of Adelaide. Doctor Wade's specialty is tele-health. She's also the editor of the Journal of Telemedicine and Telecare, the Royal Society of Medicine's periodical covering the field.
Today, Wade is happy doing telemedicine over half a megabit per second. As in 512 kilobits per second. Megabit, in the singular, is not a mistake.
Wade told me about a project in which elderly patients were observed remotely so that carers could make sure they take their medications. Just making sure patients take their meds can keep them out of hospital beds, saving time and money. Such prophylactic action is considered an enormous potential benefit of universal broadband. Wade told me the program she worked on used consumer-grade videoconferencing services with a smartphone or iPad. Standard definition video is fine, so long as the network is free of lag and jitter, and fine for plenty of other tele-health applications, too.
“99.9 per cent of tele-health can be done with standard definition video,” Wade told me. When detailed images are needed, Wade told me that specialist cameras, not more bandwidth, are what's needed. Even when such hardware is deployed, she doesn't think consultations will necessarily happen in real time.
Australia already has a service called Tele-Derm that sees general practitioners in rural areas forward photos of possible skin cancers to experts. Assessments are provided in 24 hours, much faster than would otherwise be the case but certainly not in real time.
The doctor will see you now when it suits the doctor
That day-long turnaround is due, in part, to the healthcare industry's workflows just not being designed for tele-health. Wade says the notion that we'll be able to make an online appointment to see the world's leading specialists in whatever ails is a fantasy as the profession is tied to its current workflows. Broadband speeds are therefore just a small part of what's needed to unlock the potential of tele-health.
Michael Civil, who sits on the Royal College of General Practitioners' practice standards board, told me that Medicare, Australia's national health insurance scheme, currently doesn't offer rebates for tele-health. Civil's conducted some ad hoc experiments, over his surgery's consumer-grade broadband, and found tele-health useful but not something he'll pursue until the entire healthcare bureaucracy catches up, makes it pay and figures out how to do it right.
Bandwidth alone is clearly not the answer here.
But the absence of bandwidth does raise another question, namely whether Australia is forcing itself to “dream in black and white” and crimp innovators' horizons with broadband slower than the rest of the world's. Or cutting itself off from innovations that will be mainstream elsewhere.
Telstra's innovation suggests those arguments aren't potent, as it was dreamed up over today's ADSL-dominated networks and delivered partly over wireless.
I feel we don't need to wait for our dreams to acquire colour. We can do great things now.
Suggesting that the NBN can be worthwhile without FTTP typically generates angry and critical responses.
I hope that before readers do so, they consider a few other things, namely:
- When the NBN was conceived as all-FTTP there were few alternatives for 100 Mbps connections. Today we have DOCSIS 3.1 and G.fast, with 5G wireless and XG-FAST on the horizon;
- Just because you install FTTP doesn't mean you get a great internet experience. For data to support that assertion, consider, as an example, the Organisation for Economic Co-operation and Development's (OECD's) September 2014 survey of Actual download speeds (.XLS file or item 5.5 here if your browser misbehaves) in member nations. Plenty of heavily-fibred nations average in the mid-thirty Mbps range. Yes, they've probably sped up since but so have DOCSIS and G.Fast;
- The main application said to require FTTP connections is video, usually for entertainment purposes. Miners build their own railroads to get rocks onto boats. We should build networks for Hollywood why exactly?
- In situations where more bandwidth is needed, users are likely to be in locations where it makes sense to pay for FTTP builds. Hospitals, doctors' surgeries, clinics and so on can surely equip themselves with proper connections? Buy-your-own-fibre is a one-off need, just like restaurants need bathrooms and grease traps in order to do business.
One last thing: I've regularly argued that an FTTP build remains the optimal option for the NBN … if it will be affordable and delivered quickly. Last week Australia's opposition Labor party claimed, somewhat unconvincingly, that FTTP is now affordable but dodged the issue of delays its plan might mean for the advent of universal access.
With millions of Australians still unable to access decent broadband, it would be nice to hear as much fury about that issue as the matter of which carriage medium is used to build the NBN. ®