Beer and Broadband Episode #2: Telehealth

Brian HollisterBeer and BroadbandLeave a Comment

Nick Dinsmoor: Welcome to Beer & Broadband. The podcast by people who like to bring speed to communities, but enjoy slowing down with beer to talk about topics keeping us all connected. So wether you design, build, service, or just use the internet. You’ll be informed and entertained. On episode 2. TeleHealth and TeleMedicine.

Tell me how to talk to my doctor over the internet. We join Prime Health, AMRO Systems, VETRO FiberMap, and Mammoth Networks to learn about how TeleHealth is changing the face of medicine and why Broadband is the catalyst for this change, so keep your glass full, your network open and lets get into it.

Brian Hollister: All right. Let’s get started. All right, everyone. Well, welcome to our second beer broadband discussion. My name is Brian Hollister and I’m the CEO of bonfire engineering construction I’ll be your MC for today’s discussion alongside my colleague, Nick, Dinsmoor I’ve been in telecom for over 20 years. And our business is focused on closing the digital divide for communities across the country.

What does that mean? We help facilitate and fill the gap on broadband development, feasibility studies, engineering, to construction, placement services, but more importantly, I’m even a bigger fan of beer. And today I’d like to we’ve got a great session with the team. And we love to use beer to collaborate and have great discussions.

As we’ve mentioned, in our invite our goal with Beer Broadband is to educate, connect, and inspire. And depending on how many beers we have, we probably will do a little entertaining. This will be a conversation, not a presentation with fellow leaders across the broadband nonprofit healthcare space I’m very pleased that they’re happy together with us today. And use their time and really what’s so interesting about telehealth and broadband.

We’re going to learn today how they’re intrinsically linked together. So let’s start off by doing some introductions and make sure that we’ve all got a beer in hand or some kind of cocktail. Everyone are we good? We good? Everyone’s got a drink in hand? All right. Susan All right. Wonderful. So again, everyone, as a reminder to our listeners, you can ask questions in the Q & A section of the Zoom.

We’ll try and answer those questions as we go along as well at the end today. So today we have an amazing panel. We’ve got Will Mitchell, CEO of VETRO FiberMap. We’ve got Susan Woods, Chief Medical Officer of AMRO systems. Rachel Dixon, Executive Director of Prime Health and Brian Worthen, CEO of Mammoth Networks and Visionary Broadband.

I’d like to go around the room real quick or virtual room and have each one of you do a quick introduction and tell us a little bit about yourself and your company, and then we’ll get started with a discussion. Why don’t we start off with you Will?

Will Mitchell: Oh, sure. Thanks. It’s nice to be here. Thanks for hosting and having me I as you mentioned, I’m the CEO of VETRO FiberMap. We are a software company based in Portland, Maine, and we deliver a fiber management mapping platform, a GIS platform for fiber optic network design and management, sort of supporting the deployment of connectivity infrastructure.

Brian Hollister: Thanks Will. Susan.

Susan Woods: Hi everyone.I’m Sue Woods I’m a physician technologist I’ve been in healthcare a long time. I’m an internist. I am still practicing. I see patients who have addiction and I’ve been working in the digital health space for about 15 years. AMRO systems is working on immersive technologies, virtual and augmented reality. And we’re in Portland, Maine as well.

Brian Hollister: Right. Thank you Susan. Rachel.

Rachel Dixon: Sure. My name is Rachel Dixon I’m the executive director of prime health and also an eHealth commissioner for the State of Colorado sharing the state’s TeleHealth and Broadband work group. And, Prime Health is a nonprofit that focuses on improving healthcare through innovation and collaboration, really working in across all sectors and using technology as a tool to advance health, equity, quality, and cost.

Brian Hollister: Awesome. Thank you, Rachel. Brian.

Brian Worthen: Yeah. I’m Brian with Mammoth Networks and Visionary Broadband, and we’re a broadband provider for a lot of the Rocky Mountain region and have a big presence with, the we just finished putting the finishing touches on the Thor Network in Colorado, which connects a number of hospitals, and we’re excited to be a part of this conversation. Thank you.

Brian Hollister: All right, Nick.

Nick Dinsmoor: All right guys. Um, so obviously the conversation today is around broadband and TeleHealth/TeleMedicine, but if you’re like, uh, You know, if you’re like me, you’re not exactly sure what exactly that means. So I’ve read a couple of different articles recently about what TeleHealth is, but obviously Rachel, Sue, I think, you know, you guys are clearly the experts, so let’s just start off the conversation about what is it. Let’s define TeleHealth. Let’s define TeleMedicine and get that kind of on the table right off the bat.

Susan Woods: I’ll jump in. So, it’s information and care at a distance. That’s a really sort of simple and generic way of talking about telehealth. It could be synchronous at the same time. Telephone is TeleHealth as well as what we’re doing right now, video, but it can also be asynchronous where like secure email or monitoring data that you used to submit to your healthcare provider.

Rachel Dixon: I would add, I tend to think of it as anytime we’re using technology to enhance or support the delivery of care. So, also things like symptom trackers or apps on your phone, devices for in the home. Things like that kind of also support that communication Sue was explaining about the synchronous and the asynchronous.

Nick Dinsmoor: You guys have everybody have the same opinion? Brian or Will, you guys. Brian, everybody thinks we’re good with the definition of what it is?

Brian Worthen: I’ve seen a few definitions and what’s interesting is there’s it really breaks it down into ongoing health care and treatment. So if you think about splitting it up, it’s as simple as an Apple watch and the health app, and the fact that it monitors the heart and whatnot, and then there’s the actual interaction as Sue’s spoke of where it’s two way is synchronous with the healthcare provider. So it’s good. It’s easy to call TeleHealth as overarching covers everything, but there’s multiple aspects of it. In fact, in rural America, we’ve been practicing TeleMedicine for years, with the radiology going to other hospitals and hospitals sharing, uh, you know, radiologists and sending stuff back and forth and that’s why connectivity has always been important, not just during COVID.

Susan Woods: I think one of the challenges is, I mean, terminology. Terminology does matter. And it really depends on who’s defining it. So I think healthcare by itself tends to focus on a very narrow sort of TeleHealth, remote monitoring, or video, but I agree with Rachel, but I don’t call that TeleHealth I really refer to it as Digital Health and Connected Care because not all of it requires a healthcare clinician. Not all of it requires a health provider or a health system. People can do things on their own. They can do pair online support, they can use mobile apps, they can use devices on their own. Some of that data may interact with a healthcare professional, but no of all of It needs to.

Rachel Dixon: I think that’s one of the interesting and fun things to Sue’s point is there are about five different words for it. So depending on who you ask, it’s TeleHealth, TeleMedicine, Virtual Care, Digital Health, I’ve even seen some blending between that and Health IT, and then also, even at the government level, when we look at policy, there are differences of opinion in terms of the definition of TeleMedicine used by, at the federal level, with like health and human services or center for Medicaid and Medicare versus like at the state level, it’s defined differently state by state.

It’s still very much an area in development certainly.

Brian Hollister: Right Broadband we have you know the gig economy or gig access. You have high speed internet, broadband, a lot of it’s the same, same thing, but it’s obviously emerging, it’s growing you know, leaps and bounds, still just like TeleHealth. Right? So, we like to make it as confusing as possible.

Susan Woods: Yup

Will Mitchell: I think Sue it was you that told me that The definition is it expands into the sort of consumer space too, of actually just interacting with the healthcare system or your doctor and having an online portal of some kind with your insurance company or your provider system, and setting appointments or accessing records as results from consumer to provider. And then, you know, if you’re going in and getting some sort of care there. Sharing electronic medical records and that’s fine. It seems part of what we’re playing into. Right?

Nick Dinsmoor: It works interesting as I just there was just an article that came out March 11th and it was about basically new venture deals that’ve basically been funded since the pandemic started. And the top three deals are basically a BioTech, HealthTech and FinTech. So I guess, you know, kind of proving that. What’s going on right now that even in a pandemic, there’s a lot of activity and obviously the HealthTech space.

And I guess it begs the question, you know. What factors really do play a role, in the adoption of use or use so telehealth? Right? You know, obviously we’re talking about broadband here too, but what are those factors that really impact all of us using it? I mean, I know I’ve used it myself.

What do you guys think?

Rachel Dixon: Well, I think most on the notice for this meeting is internet and technology infrastructure, both for patients and providers and, and that goes for urban and rural areas. So even in Denver, we’re having a lot of conversations around. Whether, or not makes sense at some point to look at having WI-FI, be a free public utility, since there’s so many people who can’t afford the $15 a month for internet access or who don’t have technology, that’s compatible in the home with a lot of the services that we provide, and then when we look at rural communities or even just, you know, facilities that have older buildings. Right? Where it’s the Internet’s not very good or the wiring is old or whatever that looks like of broadband and infrastructure is I think definitely one of those fundamentals factors.

 The next factor that I see a lot of is policy and payment in the health care system. So, making sure that there’s a healthcare system that’s supported in terms of allowing providers to deliver care in a way that they need to and we still run into barriers around in Colorado, at least barriers around, um, what types of providers can be located, where and where the patient needs to be located or what kinds of services you can provide and what their requirements are on those. That can be very  restrictive and tends to have a hard time keeping up with how quickly the technology and all the different care delivery models evolves. And then just making sure that we have reimbursement models that align with that.

One of the things that’s really cool about TeleMedicine is that it really supports this movement towards value based care and really improving overall the outcomes of care and the cost of care, but it’s still a new space in terms of how do we evaluate that, how do we measure those outcomes, how do we really assess that cost and prove it in a way that we can justify its continuity.

And then I think the third area factors play a role or you know so I’m listing barriers, which I think that, which is not necessarily the same, but the third area is just, is knowledge and making sure people kind of understand it, know that they can access it, how to access it, what it means, what to expect, that it is good care, all of those things and so, factors that play a role in the success and the adoption and use of those technologies is really thinking about ways to address those three areas.

Nick Dinsmoor: Let’s ask everybody here, like, I mean, does everybody, if you had to call your doctor right now. Do you know if you could actually use TeleMedicine?

Brian Hollister: Well, we just tested this I called my doctor to schedule time to try to do something virtually and to understand if there was an option and they knew of nothing. My doctor I’ve been going to for years. This family Doc, right? Because I’m not exactly really wanting to jump up and run and obviously go into a place to have a physical right now. So I wanted to know if there were, there were options. From my doctor there wasn’t, so I feel like education maybe a potential barrier here. I mean, we obviously have to have internet access, but there’s lots of us that do have internet access already. And I’m not sure if we really understand everything that’s available to us already. And while my local doctor, doesn’t it’s obviously forcing me to look at my provider and see what other options I have. Cause it’s probably smart to still so a check-up now that I’m older than 29.

Rachel Dixon: Hot tip from Colorado to your point, Brian, if you do need your provider is that all of the commercial payers. So Cigna, United, etc, do you have TeleMedicine solutions available through the payer that you can use. So that’s always a backup option and right now copays are waived um, cause of COVID.

Nick Dinsmoor: It’s interesting comment in the chat that from a provider, I guess that’s listening or watching that they’re concerned about wanting to advertise because they’re worried about reimbursement. It’s interesting.

Rachel Dixon: Yes.

Susan Woods: You asked Nick about adoption and in general, adoption requires things to be easy and things to be valuable. But we have to think about healthcare now, like BC before COVID and AC after COVID. So BC healthcare was not adopting TeleHealth to any great extent. I mean, there are, there were pockets. I mean, large systems.

I spent 10 years at the VA at the national level and there they’ve been doing it for ages. Big systems like Kaiser Healthcare, and I think you have Kaiser in Colorado. You know, they’ve adopted it because they, want to keep people out of the hospital. They want to keep people out of the emergency room, but most healthcare isn’t designed that way.

Most healthcare is designed. Fee for service. You see somebody, you get something done and they get paid. So the whole sort of easy and valuable, wasn’t really an option in most healthcare. Today all bets are off the table right now. We’ve got healthcare clinics and hospitals that are going down the tubes unless they provide virtual care.

All The rules and regulations have been relaxed. The reimbursement has been heightened and everybody has sort of, it’s sort of a wild, Wild West out there, including low-income rural clinics who are trying to adopt TeleHealth. So there’s been this dramatic change, but one of the things that technology always uncovers is. What happens on the ground. Like. Does it work well? Does it not work? Well? I mean, what happens with, when you layer on something like TeleHealth on top of the existing healthcare system, you start uncovering all the facts. Like the infrastructure’s not really there. The support’s not really there.

They can’t reach out and help people who are struggling to get in or use the technology. So it’s a pretty interesting dramatic time.

Will Mitchell: My sisters in this field, she runs the Pacific business group on health, and they’re sort of a payer coalition working on really cost control and quality metrics and that kind of thing from the buy side for large employers, but she’s a bit of an expert, but I’m not, but she tells me recently, she was telling me that a huge number of independent practices, those that are left primary care practices are at risk of going under and it just dawned on me, you know, like, well, yeah, they’re like retail or a restaurant. If you can’t go in and buy services, they’re not getting paid. So, the shift to online is necessary for them to survive. They need to get paid by delivering services like this, or however they can do it remotely and digitally.

So I thought that was quite, You know quite telling

Rachel Dixon: Some Colorado stats are that in Colorado, in the last two months, more than 40,000 healthcare workers were laid off or furloughed and at the same time, we see that more than 86% of providers have switched to delivering services over TeleMedicine whereas a BC before COVID, it was less than 20% across the board.

So it’s been a, it’s been an insane spike. It’s really fascinating to watch, but it’s also interesting within that kind of going back to this TeleHealth definition is that the majority of those visits have actually been over telephone. There are still quite a lot of some interesting challenges related live video visits, especially in the space I work in which I sort of low-income communities and rural communities, which have a lot more barriers related to tech access.

Nick Dinsmoor: I mean clearly, I mean, not, not making light of it, but I mean, you can only do so much TeleMedicine, right? I mean, there’s no proctology exams over TeleMedicine.

Brian Worthen: You are making light of it. You are.

Nick Dinsmoor: Just saying there’s only so much you can do. I mean. So there’s a line of what’s how far the TeleMedicine can go without obviously having a physical appointment. Right?

Susan Woods: Docs tend to say that. You sound like a doc. When it really comes down to it. 90% of what you do with the clinician is to talk is to get a history.

I mean, there was a comment it’s true. If there’s proceduralists. Obviously that you’ve got to, there’s a comment in the chat box about mental health, behavioral health, and yes, they’re, they’ve been way ahead of the curve doing virtual care of for a long time, because you know, that is talk therapy, but, don’t underestimate how much you can actually accomplish in a virtual visit.

Brian Worthen: I want to go back to something Rachel said earlier, and it’s about adoption. And I think of the time I walked into my parents house and they were FaceTiming with my kids. You know, they, they were incented, right. They, wanted to talk to my kids and see them. And, they were talking to my kids remotely and I just run by, we live in the same town, but they were using FaceTime before I was. And now if you think about all the people that are now using Zoom and walking their children through Zoom, Google Hangouts, Meets you know, uh, Skype, FaceTime, whatever for schooling. Right now. Suddenly this ability to receive and send information in real time has changed because it comes down to ease of use.

These are the same parents that I talked about when they had a, they had a VCR, they can’t set the clock on it, but they figured out how to use Netflix. Right? So once the technology becomes easy, the adoption comes in. Right? Right now it’s just a swirling windstorm of everybody understanding the technology.

And then if you’re a, if you’re a clinic, how do you get the word out? You do that, right? There’s no traditional marketing methods anymore. There’s no, you can’t put something on the radio. You can’t put something on in the newspaper, on TV. There’s no way to reach everyone. So how do you get the word out even if you offer that?

Nick Dinsmoor: You’re a TikTok video right now.

Rachel Dixon: That is very explicitly. The one place that is still considered, not HIPAA compliant.

In the emergency that they waived all the HIPAA restrictions for like Facebook Messenger and all of that very like Except TikTok. No TikTok. Which I thought was really funny then that needed to be said, but probably it’s a.

Nick Dinsmoor: Well that’s to play off Brian’s comment. I mean, so adoption, right? I mean, so obviously different people in different areas have different levels of let’s stick to the broadband piece of this right.

Broadband access. What’s the base requirement, you know, to truly do effective TeleHealth online. Now you’ve put aside the phone, obviously, Rachel you’ve mentioned that they do a lot of that, but from a broadband perspective, is there a base technical requirement of things you have to have to be able to have a good TeleHealth/TeleMedicine appointment?

Brian Hollister: Cheers everybody drink.

Susan Woods: Okey

I was, uh, seeing care, uh, seeing patients virtually yesterday, all day. And a lot of them were on the phone and one individual was a new patient. And I spend a lot of time with the new patient and we started with a video, but this person was actually in their car because their kid was at home and they didn’t want the child to hear the discussion. So they were in the car and it worked for about 15 minutes, and then it was, I got to call you because you’re going in and out. So yes. And you guys probably know this better than I do, but I think you need at least five upload to be able to, to be able to have a good connectivity, but remember it also has to, do with you know who else is using the service in your home. So you know how many devices there are. So you can’t just go with one individual, but you guys know this better than I do.

Will Mitchell: Yeah that shared bandwidth is a problem for certain network technologies, and Brian knows this better than I do, but you know, we, we’re in the business of helping companies that are deploying fiber to the home and a lot of places, it’s not going to go everywhere, but you know, a good wireless connection is also certainly adequate, but we experienced that. Ben with the overload just today, I was on a call and a neighbor in a pretty well developed area was what you would think would be a good broadband connectivity was on a Zoom call like this, and he couldn’t, speak the voice wouldn’t come through.

It was just dropping out so that they had reached a fail point and it was because three or four other people were in the same household using the same bandwidth. So certain network connections are, um, Not robust enough to support even this kind of conversation.

Brian Hollister: Just since this all broke out  I had a 150 mgbs broadband cable connection, and it’s always been amazing, fine, right? It serves all our needs. But now, not only with the, you know, four people in the house being on a video conference, which obviously is the hardest experience to make perfect, right? Because if we have a problem we’re hearing and seeing it, but now that all my neighborhood is also doing the same exact thing, luckily for us, there was an option where now I, I brought in a fiber connection to our home and we’re getting, you know, obviously a lot better internet, but it’s experience. It’s actually the big difference, Will, that we saw was the latency on the other technology. That latency was really affecting our two way communications. And since we’re doing this kind of stuff all the time with clients and employees and partners, it’s vital.

So luckily for me, I live in the middle of Denver and we have options, but that’s not the case for many.

Will Mitchell: You know, Brian, you were talking too about it has to be easy and accessible, and I don’t know. I think Nick, you asked if we had access to TeleMedicine or ourselves and I do. I haven’t used it, but it’s called Teladoc and it’s provided through the, the coverage we have. Family coverage. Uh, let’s see, you can dial up and have a. I think it might cost a small copay. They might even have waived them right now. Like, like you suggested Rachel, but Teladoc is an app. That’s I don’t know. There’s probably lots like it, but that’s one that I have on my phone and have access to through my insurance plan, but what’s more intriguing to me is on the mental health and behavioral health side of the equation. You know, we all know somebody who’s suffering from depression or anxiety or some other, you know, affliction or, or suffering on that front. And there are apps now that meet people where they are that I’ve been looking into. For, you know, friends and family, and one’s called Talkspace.

No, I think they’re doing a lot of advertising. You asked about how to advertise to their Western silicone they’re on billboards and things, but with movie stars, you know, back backing them. But imagine the, you know, the prevalence of depression and anxiety in the younger population, then they’re not going to probably benefit as much from once a month going into an office visit, but with this kind of tool, they can. They can text the counselor or get on FaceTime with the counselor whenever they want and wherever they are. And I think that’s a pretty important shift. Hopefully that sort of takes root.

Nick Dinsmoor: So I guess a question, I mean, obviously, you know, there’s a lot of players involved in TeleMedicine/TeleHealth, right?

So there’s the service providers, right? So people can buy broadband services. There’s the hospitals and doctors, and then even, you know, further back behind the scenes, right. There’s the people, I guess, you know, development works and deploy networks and have software to help create networks. At what point, I guess, from a. I guess let’s maybe start on the service provider side, you know. Do you help encourage use of, you know, one more application of why having broadband is important? Like, do service providers need to get more involved in the promotion of that, this new application? Again, I know it was around before COVID, but even like, is it something that we should all be promoting?

Brian Hollister: Well, I guess where does it fall, right? Is it Federal? Is it nonprofit? Is it, you know, Private sector? Meaning when we think about education, I’m really curious to get the team’s thoughts on it because we clearly have seen, so Rachel’s point a huge uptick in use, right? You’ve been forced to use, and  thank goodness we have this option for many it’s clearly probably helped flattens curve, but how do we get the word out?

What is the right means? Right? Cause there’s capabilities out there today. I mean, Rachel, I went to your Prime Health Summit and there were tons of money to all these amazing innovators doing all kinds of remote healthcare and the whole time as a broadband guy, I’m thinking that’s awesome, if you have connectivity. And there was so many amazing innovations, but what is the means of education? What do you think?

Rachel Dixon: So. Emphatically, yes. I think that as much as possible, any industry that relies on broadband or any sector that relies on broadband connectivity, which is so I guess to back up for a second, Access to the internet and good internet has really become, I think, a basic human right, and something that should be a public utility. Whether or not you have access to adequate internet influences your access to education, healthcare, economic opportunity, the quality of those resources, your overall public safety in your community, right?

Whether or not your fire department and police officers and people like that have the connectivity that they need. And so it’s interesting, Brian, and we’ve talked about this before that we see quite a lot of advocacy in the healthcare space for broadband, that our hospitals. Need broadband or need internet connectivity.

I’ve had, um, we were talking about mental health and I did a program where we brought free tele-psychiatry live video and consoles and all these other things to rural hospitals to address these significant behavioral health shortages in our state. And, uh, one of the hospitals, I was like, I’ve got this virtual, mental health practice.

We’ll give you everything you need. So your patients really free support you wherever you want. Unlimited. All of that. Like it was a program that I was doing that was paid for by the state. So it was fine. And we had our hospital CEO that burst into tears in a meeting because there. They were having such out of control issues with behavioral health and substance use and all of these needs, the nearest mental health clinic was four hours away and they really needed this service, but they couldn’t use it because they could only check their email once a week. Apparently when like some sort of satellite went over them or something like they were having such bad. I wish you would know more about, I don’t know if that’s technically accurate, but it was basically like there are only one or two times a week where they can even check an email.

So even trying to Google something, you know, or look something up or verify the dosage for a medication and things like that was hard to do. Same with education and any other space. But I don’t see a ton of coordinated effort or coordinated advocacy in the community. I see advocacy in education, advocacy in healthcare, advocacy in economic development. We see initiatives like smart cities. We see, you know, and then we have office in broadband office of IT, office of eHealth innovation. Um, we have all of these different people that are working on it, as well as foundations that fund it through the lens of healthcare or through a lens of something else.

And so, um, yeah, that touches a nerve for me and that this is something that everybody can agree we need. Um, and that is one of the biggest influencing factors today in our society as to whether what your quality of life is going to be in your community. And it’s also on the positive side, a really powerful revitalization tool for rural communities and small towns and things like that, to be able to continue to do that. And also if you think about it as a way to address the housing crisis, um, so yeah, I think broadband should be important to everybody, um, and that we should do more to advocate for that in our communities.

Nick Dinsmoor: That’s a lot to unpack.

Sorry.

Susan Woods: There’s nothing like losing money for people to pay attention. And I couldn’t agree more. I think healthcare education, energy, work. Everybody’s suffering from the same thing, which is how do we provide our services?

You know, I think of this, like a bridge, you know, I mean, they build bridges differently now, but it used to be, you know, we start building on one side and then they start building on the other side and then they meet, right?

So healthcare and education, they’re scrambling to figure out how to provide what they do normally in a virtual world. Okay. People, workers, employers, same thing, but on the community side, on the consumer side, children, people, families, you know, who’s paying attention to that digital equity? Who’s paying attention to the last mile? Who’s paying attention to digital inclusion?

 People don’t have, can’t afford the connectivity. They don’t have the devices, they don’t know how to use them. So it seems to me that what Rachel, what you’ve been talking about is a perfect opportunity to start aligning across these ecosystems for the same exact thing, which is to really start empowering our communities and creating those public private partnerships to do, to do what needs to get done, because I mean. Healthcare’s not going to support the people in their homes. They’re not going to do it. Education’s not going to do it either, and it’s really behooves the communities, the local governments, state governments, federal governments, the private sector to come together and figure out how to do that digital inclusion piece.

Nick Dinsmoor: So Brian, Brian, and Will. You’re on the back end, right? The infrastructure of, I mean, you are what I’d say 90% of the population has no idea that goes on, that allows things to work. What are you guys considering now? Knowing this, knowing that this is. This is coming and it’s, you know, AC like, you know, what are you guys considering from network planning to promotion, education?

What are you guys thinking about relative to this topic?

Brian Worthen: I think that’s an interesting part of the discussion. We’ve been talking about promotion and promotion at TeleHealth and how it, how a provider should be doing that. But I can tell you this. Having been in this business 20 years, the adoption of technology happens on its own.

So once something’s easy enough to use. It is used. The example of my parents again. Once it’s easy enough for them to use, they’ll use it. Once Zoom is easy enough for a third grader to do their, to do their schoolwork. They’ll use it. There needs to be a common acceptance and ease of use for TeleMedicine and TeleHealth.

And there’s nothing I can do as a provider to change that I can promote that all day long, but I just have to be ready. You know? So we’ve. A few years ago, we realized we really can’t shape how people use the internet. For whatever reason.

We tried to include certain services with internet, you know, whether it’s voice or, or TV or whatnot, and everybody wants to do their own thing, but has become a utility.

And so in the last couple of years, we’ve just shifted to planning better networks, and planning, bigger pipes. The discussion was had, you know, we’ll mention this upload and multiple users in the, in the home sharing an upload. I talked about this in the last couple of weeks to multiple people. We’ve seen our work orders double because people are migrating and mass op DSLs. Too latent for video calls. It’s too late for voice calls and it doesn’t have the upload. And so as a provider, we’re simply preparing for that wave. And what’s interesting about this is COVID has brought it all to the forefront and we know what’s coming as a provider and Brian and I were talking about this before the call. We know that there’s a storm coming. There’s a wave iand that’s an opportunity but it’s going to be a huge amount of pressure for everyone in the broadband industry to keep up with what’s going to happen next, because there’s going to be a question of whether schools are in session, come August and September. There’s going to be a question as far as when medical professionals who are furloughed go back to work and what that looks like after this.

So I could talk all day long to my bias and say, I’m going to hand you a device. I’m going to hand you a Fitbit. I’m gonna, you know, I’m gonna. I’m going to defray some cost of an Apple watch, so you can monitor your heart, but there are some people that don’t use it. There’s some people that, that say, Hey, I’m an Android user, right?

You don’t have a single product to appeal everybody as a provider. But what we realized is we have that one product and that’s the pipe.

Will Mitchell: We’re one step upstream, even from Brian, you know, we provide tools. We are in the, kind of, efficiency business where the design and deployment of those networks that Brian’s deploying and we work with, with Brian’s company and many more is around the country and even globally. They’re all sort of saying the same thing. There’s this sort of pent up demand and this surge in demand, that’s just gotten really exacerbated and intensified. Networks are going to have to get designed and deployed a lot faster, to a lot more places.

We’re trying to help in that regard, providing software. That’s easier to use, you know, but again, we’re way upstream. You’re connecting the providers as well as your middle mile networks. And that’s critical. There’s a lot of investment going on into that space. And I think rural health facilities and hospitals and others and providers, a lot of the people we talk to are more worried about that last one last mile to the home and doing the drops in the rural neighborhoods and connecting the actual homes.

So on both sides of that bridge. The provider and the consumer, I guess both need the same kind of high quality connectivity to make this work.

Brian Hollister: I think evolution is happening right in front of us. You know, overnight went from businesses driving traffic during the day and residences driving it in the evenings, and and overnight we flip-flop that traffic. That’s had a huge impact on networks globally. We think about designing these networks. So there’s a lot of time that goes into trying to come up with the best design and utilizing, you know tools like Will has, you know, working with service providers, trying to figure out, well, what do you have in place? You know, what kind of existing assets can we leverage?

Because especially as we’re building these networks in rural America, the cost per customer is obviously very expensive, but I do believe we’ve been seeing this evolution happen over several years now, where more and more rural communities say “We gotta go build this network ourselves”. Right? I think in the chat room mentioning Chattanooga high-profile, great town, shoutout to Chattanooga, is really doing some really cool things and it brought gigabit to everyone there and that’s no easy task, right?

You’re building infrastructure, that’s physical and it’s something we can outsource to cheap labor by any means. So, there’s uncertainty. We’re not sure exactly. Where are the builds going to be, because there’s a transition happening right now. We have three office locations that are being used and most of them have two pipes in there for redundancy.

And. So, what are we going to do? Um, but the good news is this pent up demand is coming and it’s going to be actually a good news/bad news thing, right? Because there’s only so much product out there that can be produced. You’re going to see a lot of these communities that know they need to go ahead and build these networks finally decide to go ahead and do it. Or they’ve been sitting on the sidelines because it’s a lot for community to try and go build something they’ve never done before. Right? They’re going to take that on themselves, and then it’s just one aspect of broadband development, and you’re going to see more and more of these folks, jump in and say, let’s go! We’ve got to do this for the community.

But then that’s going to have a huge impact on supply and demand. There’s only so much capability across the country to do this type of work and the work has been very strong with 5G and the proliferation of broadband across the country. So it’s going to be a good news/bad news, kind of, essential challenge that we’re gonna have to work through.

Nick Dinsmoor: Anne says for those who we were on  earlier, saw Will’s cartoon, you know, 5G you know, it is the root of all evil right now. Right now. Right?

Just kidding.

So let’s, I guess, change gears a little bit and talk about the roadmap for both TeleMedicine and Broadband. Is there, or should there be conversations that there is a truly an integrated roadmap, whereas not just telemedicine goes down one path, the broadband, companies, both from network design to implementation, to service and go down different paths.

Should there be an integrated roadmap? And if so, who leads that?

Rachel Dixon: So I can speak a little bit to what we’re doing in Colorado around that right now. That is a hundred percent something that we’re trying to figure out and run really how do we coordinate across sectors as well. So we’re very fortunate to have a really wonderful office of broadband here in Colorado, a similarly kind of creative, open, easy to work with leadership.

Um, and then we also have a number of really amazing foundations. So, most of all in Colorado, we see that the Colorado Health Foundation is really interested in, has they also identified this need for broadband and the impact it has on communities. So they have, they have been doing kind of a mapping exercise of Colorado for the last year where there are communities where improving broadband access will make a big impact related to equity. So, for those of you who are familiar with equity, that’s like making sure that everybody has the same opportunities and the same rights and the same resources, regardless of where they live, how much money they have or what other circumstances they have in their way. That’s been a really exciting initiative, and I think that, frankly, because broadband is so expensive, right? Building internet is so expensive and funding that comes from the federal government can be complicated. It’s really nice when we see foundations and investors at the table. So there are also a number of investors that we’re seeing in Colorado, like Arcturus, um, that are investing in the building of broadband networks in communities where they think there’ll be a pay off 10 to 20 years down the road related to economic growth.

And so those initiatives have been really big, and then also the local municipality stuff has in Colorado has been a big deal, as well as the electric collapse doing that. So those are a lot of the strategies that we’re seeing, at least in the healthcare space, uh, ways that we can, we can do this, but our big initiative, at least their prime right now.

Is to try to build more bridges of collaboration so that we can have kind of a bigger coordinated ask as opposed to three different sectors from the same community, submitting proposals for funding, rather let’s instead have a big push that we need this funding and we all agree. It tends to be a lot more powerful when we have those big numbers and that big picture, as opposed to this one hospital, it’s really not this one hospital. It’s this entire community and every school clinic and other resources within it.

Nick Dinsmoor: So I guess, and maybe this is to Brian, either Brian. I mean obviously rural communities have. They have service providers, they have wisps, they have electric co-ops they’ve got a lot of different people there. I mean, to Rachel’s point, how do you, if you’re trying to get the big picture, you’re trying to get everybody involved. Is there a central forum? Is there someplace where all these people that are basically constituents and trying to kind of bridge that digital divide.

Where can they come together?

Brian Worthen: What’s interesting is it’s about amenities. There’s been discussion on Chattanooga. That’s a good size community. Uh, what about a community, the size of Gudnason or Crested Butte or somewhere in the Rifle, Colorado. Right? What happens? And I see this a lot is there will be a push locally.

So someone becomes vocal or gets frustrated and they’ve got a direct TV or dish service and they, and they see what’s advertised in Denver. They see what’s advertised Colorado Springs. And they say. Why is that on one side of the fence and I’m on the other? And so there’s this push for as broadband community.

What happens, I see, is at some point the community as a whole draws, some sort of shape around the group they’re trying to capture and I’ve seen situations where somebody lives 10 miles out of town, and they’re the ones that are being most vocal about broadband. And it goes to an RFP and there’s a public private partnership formed, or somebody does it on their own or, or somebody enters the market new and it still doesn’t solve the problem for that person, 10 miles out of town.

So what we’ve got as amenities problems. So it’s no different than, than me having access to three good restaurants within 10 miles of my home versus going to Denver and having 30 good restaurants. Right? I don’t have options for broadband when I’m 10 miles out of town, I don’t have options for a good upload.

I might be on a satellite, and so I’m always going to have this amenity problem, and I’m just going to use that word because I am going to be at a disadvantage because of where I live and the most interesting thing about this, when you pair it with the question, what am I doing to prepare? One of the things we’ve discussed in the last week is what happens when people in the, in the Metro Market say, you know what, maybe there’s too many people in this area and I want to get out into the free air.

Right? And I don’t want to be exposed to a COVID like environment in the future because my healthcare can’t keep up. So. What’s interesting is there’s people now in the Metro market, looking over the fence at rural saying their hospitals are open, they’re able to take patients, but they can’t do that in New York and LA and San Francisco.

Right? So, there’s now a Metro focus on the other side of the fence and those Metro folks, and this is what we’ve discussed internally. When they start migrating a little bit, you know, it won’t be in mass, but when they move to that 10 mile home, that’s 10 miles away out of town, they’re going to have a broadband problem.

It’s an amenities problem. And the broadband divide is actually rural Metro and it always will be. It’s not class so much as distance and we’ve all said on the call. Everybody on this call said it, the cost to construct broadband is massive. It’s huge. And no matter how much attention to it right now, it won’t be solved next year.

Brian Hollister: No. I think the only thing I would add to that is as we’ve seen some of those developing platforms have brought a lot of positive things, but the challenge is even in those areas, they’re still going to treat some of it while it might be a tier three town, or four. They’re still going to have an epicenter of what’s going to get broadband first, and even if they have that person, that’s 10 miles away, they’re at the very end of that build cycle.

Right? Cause it’s going to take the longest amount of time for them to see a payback, even if they’re getting government money as well to help fund it. So, we still have major challenge with density, the small other density that more it costs, and the harder it is for you ultimately to have connectivity, and so there are some options, like a satellite type connection, but you can’t do what we’re doing right now in satellite.

The propagation and the upstream challenges. You’re not allow this to work. It’s better than nothing, right? There’s still some aspect of care that could be had via email and things like that, but you’re not going to have a two-way communication.

Susan Woods: You know, part of the issue of a roadmap is that everybody has a shared understanding of what they’re talking about and that is the same.

So, a lot of people in healthcare and education, they don’t necessarily understand the pipes. They’ll throw things out and use terms all the time. They talk about 5G. So, there’s two things I think that our real opportunity and Rachel talked about it a little bit. One is. There are huge natural allies happening right now. In education, lawyers, healthcare, across the board. There are huge natural allies that want the same thing.

They want affordable, reliable connectivity. And yes, it’s rural, but I have to throw in. There is a digital equity here, problem here that has to do with people of lower economic income. They might have flip phones instead of a smartphone and they have no access to the internet and they could be in the city.

It’s not all rural. The demographics to access is rural and income. Period.

Back to the allies. So you have all these natural allies that I think need to be simply educated. You know, like what, like the federal standard of 25 down, 3 up. It ain’t working. It ain’t good enough. The data is not correct. The idea of, you know, Maine has, you know, 90% connectivity is wrong.

So, I think it’s really important for the folks in broadband and connectivity ecosystem to inform people very clearly and simply with some very simple consistent messages about what, you know, what it would take, but in the other direction, the people in education, the people in healthcare, they are the ones who should be telling the stories. That are going to provide the advocacy. They should be the ones who are providing the information about what they can achieve through virtual care, but what they can’t achieve when that care can’t be provided, because there’s not enough connectivity, those are the stories that are gonna make or break where we need to go.

Brian Hollister: No, I just feel it’s a siloed approach right now. Right? And this is an opportunity. This is why we started this series was trying to bring people together to share these stories and you know. How can we be a catalyst yo start connecting some of the dots? There’s a lot happening on innovation in healthcare.

There’s a lot of various funding mechanisms for healthcare to try and help with the broadband component, and then there’s also lots of funding associated with just part being on its own, and I feel like they’re not working well together. Right? And I’m not sure what the answer is, but I do, you know, Nick and i had this conversations. During this type of situation that we’re going through with COVID. This is an amazing opportunity actually, you know, in the realm of innovation and bringing groups together because they’re really having the same exact problem. Right?

So we’ve got to be able to get this connectivity and Susan I’m so glad you said it. I  mean right here, our public schools, you know, I think it’s like 12% to 15% of the kids don’t have broadband access. Right? So, as they have started to worked from home. They’re not. Right? And then, they’re trying to do a lot of things, you know, WI-FI hotspots, this and that, but still so many don’t have just the basic access to keep up with their classmates and what’s going on. Right?

Brian Worthen: And I think that’s the stark reality of this. Right? Who would have thought that there’d be that many issues in a Metro market? Right? And the point I was making earlier, in response to Nick’s question is, no matter how broadband is looked at, and again, everybody in this call recognizes the need for it to be available and universal and whatnot, but the fact of the matter is when people look at a broadband problem, they actually try to solve the equation for most, and that’s what we’re seeing now. Is the equation has been solved for most in the Metro market. Sue was pointing out low income. You’ve pointed out students without sufficient broadband to do perform schoolwork. And I see the same thing in rural areas where the guy that’s 10 miles out of town. His problem’s still not solved although he may have been the one that advocated for a broadband solution. So we’ve got to get out of the mode of solving the problem for most and solving it for all.

Nick Dinsmoor: Well, I guess on that note, as we’re rounding out the hour, let’s talk about how the rest of 2020. Right? So, you know, obviously there’s a lot going on, but where do each of you see the rest of 2020 going both from, I guess, momentum and funding, right?

I mean, at the end of the day, obviously there’s a lot of money thrown towards this, but what’s your guys’ prediction? What do you see happening for the rest of this year and going into 2021? Both from the energy and momentum behind both on the healthcare side, nonprofit side service provider side, as well as the funding.

Rachel Dixon: Well in Colorado, we’ve been using the expression, never let a good crisis go to waste. And I think we hear quite a lot in public health, but in that sense, broadband is, is definitely top of mind. And so, in Colorado, at least what’s exciting is that we’re seeing a ton of alignment across most of our state agencies and departments, which if you’ve ever worked in government at all is not always the case.

So that’s been pretty cool to see. And then just a lot of consensus around that. We’re also seeing that our legislators are really advocating for that much more locally at the federal level, because much of this is determined at the federal level with the FCC and. You know, and, and other groups too, that have influenced like the office of the national coordinator for health, it that can support. And HRSA is a big voice in that conversation as well, health and human services. So that’s been nice to see. And then again, you know, talking about foundations, it’s pretty cool. We actually have Bruce Byington as one of our attendees on this call. Who’s the Chief Innovation Officer for the Colorado Health Foundation, and so they then again, mapping broadband and, and leveraging their resources and their pools since they work across a number of sectors. Um, as well as with, you know, pretty much all the foundations in the state, too look at how can we work together to address this and communities to advance equity.

And then the nice thing too, about a funding strategy that we’ve seen work well in Colorado is this concept of federal matching dollars, and that’s one of the places where the state has been really clever in pulling in resources and where the foundations have been really useful too. And that typically, if you can show that you have a certain pool of funding right now, we have a 90/10 federal matching. So if we can pony up 10% of the funding and show that we have that then we can get, and then a 90% match, which is huge. Right? That takes us from a hundred thousand dollars to a million dollars. Um, and so there’s a lot of those initiatives happening. And then, the other place say we’re seeing a lot of really good work as, so kind of going back to the foundation and how we can use dollars. Is seeing foundations partnering with investment groups.

And so when we’re thinking about how do we raise the capital needed for innovation. Partnerships between foundations and investment groups help reach those different resources and make that case of, Hey, invest your money here in this thing that’s important to us and we’ll support that funding. And then, you know, all of that works really nicely, especially then when we look at that coordination with state funding approaches for federal matching dollars. And so I think the more that you can see this kind of collaboration, and, and again, to that point of these different sectors, there are really amazing foundations that focus on education, really amazing organizations, both in the investment community and the nonprofit community that focused on economic development.

Um, I think smart cities is an exciting opportunity and place for, for more innovation in terms of how that’s been working. And, um, Microsoft has partnered in that smart cities alliance in terms of how do we look at designing communities that do have my ubiquotous, WI-FI access and technology wired in.

So, you know, we see James on here, people are using that Microsoft donating access points. So I think that there are a lot of interesting things there in terms of all these different public private partnerships, and really leaning on that.

Will Mitchell: There’s a renewed kind of imperative and momentum towards investing in conductivity infrastructure from the federal level too. And a lot of people in our space are gearing up for this rural digital opportunity fund art off auction. $20 billion going out to sort of facilitates or subsidize unserved and underserved area build out and connectivity in the scheme of things, this is, it is expensive, but as infrastructure goes, it’s not that expensive. I mean, we’ve got towns here in our area that have built fiber to the home for, let’s say $3 million for a whole project. Maybe a bigger town might be 10 to get bigger than that. But these are smaller towns. They’re doing ubiquitous or complete connections. As you mentioned, Brian, to everybody fiber to the home.

And then you’ve got, you know, in the outcome health care side that the spending is just, you know, add some zeros. You got a hospital putting $300 million into, you know, a building upgrade. That could fund whatever, you know, 50 small town fiber-to-home projects. So even in the, in the health care economy, there’s so much room for cost savings, really claw back some of that somehow, and put it into broadband.

Rachel Dixon: You know, one other thing, heck yeah, by the way, on cost savings and demonstrating how it reduces costs in healthcare. I think that’s huge. The only thing I’m going to add after listening to you, Will, was. This is also a really good place for citizen action, right? When we think about areas where people could get involved and really mobilize in local communities, You have a lot of leverage at the local community level to say what you want your internet connectivity to be like in your community, and to organize around that and local communities whether it’s a city, the County, a municipality, a region, a state. They have quite a lot of power and agency in terms of advocating for that, and so I think something we haven’t really talked about yet is the role of the public in terms of saying. We want this. We want to have a vote on this. We’re willing to add an extra 10 cents in taxes a year. If it means we all get free, awesome WI-FI. And there are also a lot of other things that we can do around access to technology and devices, which was what I was talking about earlier.

And there are a lot of really interesting models about that, but I think we need more people having a fit about the state of broadband.

Nick Dinsmoor: Are you ready to fire some people up? Light a fire.

Rachel Dixon: Yeah.

Nick Dinsmoor:  Are you gonna pull? You wanna pull out a six pack of something.

Is that what you’re trying.

Rachel Dixon: Where’s my tequila? Give me a megaphone and I’ll call a strike, yes.

Nick Dinsmoor: Yeah. get yourself fired up.

Brian Worthen: Rachel’s making the same point I made earlier that people with the loudest voice bring  attention to a matter, but then when something’s partially solved those louder voices go away, we need to keep being loud.

Nick Dinsmoor: So we’re about out of time here, guys. Um, and obviously we could talk about this.

I mean, I think we’ve talked about having multiple discussions in this space, but I guess maybe. To close, I mean, you know, Rachel talk about a lot of different points and, uh. Sue you did too, as far as education and knowledge, but you know, obviously we are in a pandemic, right? We’re in a situation where the mindshare is tough. People unemployment is sky high. People are stressed. Obviously mental health is on, is an issue. So in a situation like this, if you had one thing, one thing each of you would tell, like to get to that, that goal of, you know, education. Getting to, you know, bridging digital divide and trying to bridge that and equity, what’s the one thing, not 10 things. What’s the one thing you would want people to try to take away and to do, because obviously there’s only so much mindshare you can have. Right? And people just don’t have the mental capacity to keep doing everything. It’s like, you can’t that all saying, can’t eat the elephant all at once. You can only, you know, start at the tail, or, you know, go from there.

What’s that? What would be that one thing each of you would want everybody that’s listening and as we distribute this out, what do you want them to take away?

Brian Hollister: I think, for me the biggest thing is really carrying on from what Rachel saying. US consumer, have an amazing voice right now. Bigger than you’ve ever had and it is a right. It should be a basic right, for all citizens of our country to have broadband and adequate broadband, not only TeleHealth, but all the different things we’ve talked about today. So, you know, don’t let a good crisis go to waste.

Susan Woods: Great. I think with this crisis, I want, I mean, I wanted healthcare to redesign itself for a long time. And now is the time for virtual to be the default for virtual, to be the care for people with. Mental health conditions and cancer and problems going face to face. That should be the default. So it needs to be flipped on its head, but the system has to make sure that people, that it doesn’t perpetuate disparities. There have to be mitigations where people can get help getting that access and not just dependent on having versus not having.

Brian Hollister: Awesome. Any last words?

Brian Worthen: I love how this evolved into raise your voice, speak out, get involved in the community, stuff like that. You won’t to affect unless you’re involved. You have to be involved.

So I love that concept. I think that’s a good takeaway for me, for sure.

Brian Hollister: Absolutely. Well, listen, all, we’ve come to our time to close this session of Beer & Broadband, and I want to thank all of you for your insight. A lot of great conversation. And I think we’re really ending this with, we all know we need broadband.

We all know we need beer too. And I really look forward to everyone’s participation in another future event, and thank you so much for spending your time with us today. Thank you everyone.

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