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My daughter broke her leg on Saturday, and despite my worry for her, I spent a considerable amount of time at the hospitals where she was treated noticing the variety of familiar technology used by the doctors. While some of what I saw was awesome, I […]

iStock_000009376751XSmallMy daughter broke her leg on Saturday, and despite my worry for her, I spent a considerable amount of time at the hospitals where she was treated noticing the variety of familiar technology used by the doctors. While some of what I saw was awesome, I also saw firsthand how critical consistent, fast broadband speeds are to the success of telehealth programs.

We went first to an urgent care clinic near our home in the hopes of avoiding the emergency room. No such luck. The diagnosis of a broken leg with the potential for a hip injury sent us over to the Dell Children’s Medical Center. But to get the address, the doctor at the urgent care clinic had to check his iPhone, as the web connection there chose that very moment to go down. So armed with a CD containing my daughter’s X-rays, we drove to the emergency room at Dell Children’s and signed in.

We handed over the CD to the nurse, and then we waited. The doctor came in and confirmed the leg fracture diagnosis, but said he needed to consult with the on-call pediatric orthopedist and an on-call radiologist about the possible hip injury. Neither needed to come into the hospital, our doc explained, as he could just send them my daughter’s X-rays at home.

That was pretty cool except for the fact that the large image files would take at least 15 minutes or more to transfer (we waited far longer, but that wasn’t due to slow broadband speeds). During that time, I wondered what the doctors’ connection speeds were and whether or not they had caps on their home connections. I wondered also if the hospital provided their docs with business-class web access in their homes in order to speed up such file transfers and avoid going over a cap, which reminded me of how, during Time Warner Cable’s attempts to implement its tiered pricing plans, among the leading opponents were doctors in New York. Eventually, the ER doc heard back from the orthopedist and radiologist and determined that it was a simple fracture. Meanwhile, technology eased our wait, thanks to iPhone applications I downloaded that were recommended to me by a colleague, as well as my ability to play old-school DVDs on my MacBook that my daughter could watch.

However, this experience, especially after Cisco’s announcement Friday that it plans to work with UnitedHealth Group to provide telehealth in rural areas, has me even more convinced that we need faster broadband everywhere. Too bad the stimulus money doesn’t so far offer that.

  1. Hello Stacy,

    perhaps the most important: how is daughter?

    Tariq

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    1. +1 on that Tariq.

      We are all hoping that the little brave one gets back to running around soon.

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      1. GIGA…please…

        I wonder what we all did before TV and computers?

        I blew out my knee and before both and I still run….after the invention of both…I blew out both rotator cuffs dog mushing/skijoring in Alaska…with no medical attention after….

        What happened to the family doctor who could fix anything?

        Sorry, but still today with all these “things” that we think are really important, Eskimos in Alaska just go to the village clinic and have excellent care. They don’t need broadband to send messages up and down the Yukon River for advice….

        When all the illegals in the USA have your kind of treatment FREE and WE taxpayers pay for it…then we are finished.

        Best regards to your daughter…but, I think you have a limited view of the world and its people and what all of those people do on a daily basis just to survive….

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    2. Stacey Higginbotham Monday, August 17, 2009

      Thanks, Tariq. She is doing well despite her cast. She loves getting wheeled everywhere in a wagon (she’s not yet, 3 so she can’t do crutches), and can’t wait to decorate her cast. She’s handling it far more gracefully than her parents. Plus, she’s getting ice cream every day :)

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      1. one word for mobility: Bakfiets !
        http://www.bakfiets.nl/eng/

        as for broadband for businesses, I wonder how many are stuck w T1s vs. moving to multiple Business DSL lines.

        i would gladly go with higher taxes in return for a _real_ broadband component to Health Care Reform. Wire ‘em up – Fiber to all healthcare facilities that provide urgent care or have > some number of patients per day. How is this different than city/state/federal codes mandating roads for access to these facilities ?

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      2. Wow 3 years old and she’s already quite a Stuntwoman :)

        I am glad that she’s doing well.

        Tariq

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  2. Hope your daughter gets well soon!

    I think you (as many others still do) confused the stimulus with the plan, but are probably not far from the truth. I think the stimulus was ment primarily to cover rural and urban areas that do not have any form of wired or wireless broadband available (with exception to sat… not really a competitor). The broadband plan, currently starting with meetings and working it’s way to a 2010 completion at the FCC, is what is meant to extend (or at least push) next-gen broadband from the larger cities to urban areas that still have gen 1 technology. Unfortunately, it is beginning to look as though the new FCC boss may be as tied to lobbyists as his predecessor. So far the “meetings” have only started watering down the data collection methods and what is to be put into the plan. I can only hope that Obama puts emphasis on the broadband plan (and pressure on the FCC) and it’s increasing shortfalls as soon as the health care issue is put behind him. It is said that we are the only developed nation without a broadband plan… I fear if emphasis is not put on it that we will end up with another problem: a nation broadband plan that does absolutely nothing!

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    1. Stacey Higginbotham Monday, August 17, 2009

      Jim, I am aware of the broadband plan and it’s focus on next-gen service, but I am also frustrated by the fact that we’re so far going to spend $4 billion (in the first tranche) to deliver 768 kbps “broadband” to unserved areas. I think our stimulus should deliver true broadband as part, rather than speeds more appropriate to email and early web surfing.

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  3. Ugh… I am sorry to hear about your daughter. But thanks for sharing your experiences, it provides good context to the need and reality of broadband. I often take note of the tech that the folks who come to fix a refrigerator or check the electrical meters are using. While it doesn’t have the glamor of an “iPhone” – its the cogs that keep the machine going (or not going). Watching my wife (who is healthcare and will work from home) and the tech she uses, I am kind of blown away at their choices.

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  4. I really wonder… broadband…. usage & expectation from it from country to country is so different. You are using it for something as critical as this which is a real help for a place like ours where the specialist is not interested to go to remote place. But we out here in India still call a 256kbps+ pipe as broadband… what speed/throughput and file size did you refer to in your post for the 15min transfer of the X-ray image?

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    1. Stacey Higginbotham Monday, August 17, 2009

      Mrutyunjay, I don’t know what the home speed of the doctor’s network was, or the hospital’s network. The files were around 172 MBs, and judging by this calculator ( http://www.ibeast.com/content/tools/band-calc.asp) it would take 15 minutes to get that over a 1.5 Mbps pipe such as a dedicated T-1 line. I know that other images and charts can take up to a couple of GBs to send, but even if most people have access to faster pipes, the U.S. is spending billions to deliver 768 kbps as part of its stimulus to unserved people, who are also the least likely to have advanced medical centers near them. It doesn’t really add up.

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      1. Digital xrays in their original format can weigh in the 10-100′s of MB. Lets not even start talking about other advanced imaging methods which can push this into the GB range. What should be noted here is not simply the bandwidth issue of moving images around. You were fortunate here in two regards. Firstly, the mere acquisition of this data digitally is borderline amazing and a testament to your decision to go to a clinic initially. I find it hard to believe that your er would provide you with a cd of your xrays. I know for certain that many er’s here in NYC would not and would probably look at you askew if asked for a digital copy. Secondly, the fact that the other consulting physicians had the capability of opening the images at all is also something to be noted. Most medical images are written in a format that is compliant with the DICOM standard, thats why I’m not entirely amazed.

        Unlike the DICOM standard that exists in the imaging realm, there is no similar standard that I know of that exists in regards to structured textual data. If, lets say, you needed to transfer a complex specialists note from one point of care to another the easiest way to do it would be by fax. The myriad of EMR’s and their ilk that exist today make very poor attempts at importing/exporting data. Where we win on choice we lose on compatibility. It obviously doesn’t need to be this way but there is no incentive for for-profit EMR providers to play nice.

        Coincidentally, my mother broke her leg August 3rd. My brother just happens to be a radiology resident and was able to get downsized xray images emailed from the er (as a professional courtesy) to my mothers primary orthopedic surgeon which forestalled immediate surgery. I look forward to the day better electronic communication amongst health care professionals is routine rather than unusual. I wish your daughter best, no doubt she is in good hands.

        Alexander Sicular
        Director, Medical Informatics
        Columbia University, Department of Neurology

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  5. I hope your daughter recovers soon. I wish the doctors and hospitals use cloud source tool like Google Health, so they can put them in the web and share the large data files. My local cable Time Warner increased the broadband rate by $10 but the speeds are still the same lousy. They are stumbling blocks for progress in the country.

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  6. My Kid was in hospital recently in another state and about two hours away when she fell off her bike and bruised her spleen and was in for about a week and my wife was lucky to find a very weak unsecured wireless connection in the hospital that she piggybacked onto so she could still work while staying at the hospital but most of the time she went to the local library in the area ,

    My Wife asked the hospital if she could buy wireless access through the hospital but they didn’t provide that service .You would think in this day and age that that would be a service hospitals would be offering wi-fi service to patients and it could be a tidy revenue stream ,

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  7. yep we need faster broadband access everywhere
    it was nice of you to share your personal life experience to make a point
    and hope your daughter gets well soon :)

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  8. I am all for faster broadband to enable TeleHealth systems, but what really concerns me is the security (or lack thereof) of my healthcare information that this may create. Just imagine a doctor downloading a chart/file with PII on it to a home PC running Kazaa which is sharing the same folder with the world. Most hospitals do not have the same level of IT support/funding to enable this kind of collaboration like an enterprise.

    Hope your daughter gets well quickly!

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  9. It sounds like radiology labs should all have systems to post results to a secure server, since docs will probably have much better download speed than upload speed. This would let them send a URL (or account info) to colleagues, instead of sending the files. There might need to be some private key held by patients…

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  10. That you were thinking of this after your ordeal is interesting….but some good points raised.

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