Opinion: Broadband is needed, and needed now

Many of us have been talking about broadband for at least the past two decades.

Dr Terry Cutler. Credit: CSIRO

Actually, different groups have been having different conversations. That, I think, is why we have made so little progress.

The announcement of the National Broadband Network and the establishment of NBNCo have tilted discussion and debate towards an unhelpful focus on just the infrastructure rollout and what is a massive civil works program.

We need to get a little more perspective, especially around the topic of why we need this infrastructure and how we could put it to good use now. By focusing on the public benefits from possible applications we might also promote a more informed discussion around the possible network service architectures and the public policy issues around access, pricing and regulation.

I argue strongly that the national benefit from broadband infrastructure could probably be justified solely on the social and productivity gains realisable in the areas of health, environmental and resource management. That is without also looking at what we can learn from past patterns of adoption or from emerging trends in demand. It is time we moved away from the simply sloganeering that broadband will simply enable people to download movies and pornography faster and that "it is a conspiracy against taxpayers".

In the case of population health we know we have a major problem. Health and social assistance employ 1.2 million people, and the workforce grew by 12 percent between 1995 and 2000. Nonetheless, this professional workforce is ageing and everyone predicts major skill shortfalls in the near future. My health sector colleagues also tell me that there is little correlation between the number of doctors and health outcomes. More staff is not the simple answer.

This is because national health budgets are escalating out of control. Australia currently spends about $100 billion a year on healthcare, or 10 percent of GDP, and this is predicted to double before the end of the coming decade. This is because the demands on the system continue to increase. Our population is ageing. The 2010 Intergenerational Report estimated that the percentage of Australian aged over 65 will grow from 13.5 percent today to 19.3 percent by 2030.

We are also living longer. Average life expectancy increased by around 30 years over the past century. But there is not necessarily a commensurate improvement in the quality of life as these trends are accompanied by an increase in the incidence of chronic disease and preventable ill-health. Mental health problems are also on the rise.

Moreover, health outcomes are not distributed evenly across communities and levels of health literacy are also uneven but generally disturbingly low. This means that people's ability to manage their own health and well-being and to use health support services effectively is limited. Less than 10 percent of current budgets is allocated to preventative health.

These demand-side pressures are compounded by supply-side inefficiencies, often making the health system a dangerous place to enter. Legacy institutional frameworks produce workforce and service delivery silos and there are wide disparities in the availability of services across the country.

Against this backdrop it would be naïve to suggest that eHealth solutions are the silver bullet. A broad health reform agenda would probably encompass changes in the roles of health professionals, an increasing policy focus on prevention and the promotion of wellbeing, as well as increasing efficiency through technology platforms.

To date, a lot of the e-health implementations have focused on siloed parts of the system. The potential lies in our use of information and communications platforms to reinvent business models and processes across the whole system, as has happened in other service sectors such as wholesale trade, financial services and communications itself. These sectors, significantly, were the main source of Australia's productivity growth from 1994 to 2004. The rhetorical question is "if we can get such gains in other sectors why cannot we do the same in health?"

Read on to Page 2 for Dr Cutler's opinion on the potentials of, and barriers to, effective e-health services.

As a starting point, we need to recognise that the health system is a complex ecosystem. The transformational power of the digital revolution is the way it enables networked operations, linking previously disconnected parts of the system. The network platforms enable information flows and it is access to information and better information exchanges that facilitates better health outcomes through changed operational processes.

Seamless access to patient health records, medication data, and care plans makes the whole system more intelligent - and citizen access to online health information, triage services, and medical peer to peer consultations through all the forms of teleconferencing promote a more joined-up and collaborative framework for service delivery.

Professor Peter Brooks reminds us that "80 percent of diagnoses can be made by taking the patient history alone", which is why online consultation and triage has such potential to treat people outside our costly acute-care facilities. It also provides better service access for people in non-metropolitan areas. In Queensland, a Professor of Geriatrics runs the Geriatric Ward at Toowoomba Hospital, which is 130 kilometres from Brisbane, from his office at Brisbane's Princess Alexandra Hospital. There are numerous similar examples around the country.

But what if we could do the same thing with people in their own homes, particularly as more people become housebound? How much would become possible with a high definition Skype-like service and remote monitoring like the health equivalent of a smart energy grid? Think of the savings and convenience of ePresciptions and "call back" forms of care.

In addition, we can provide the tools to help people become more informed about health issues and better placed to manage their own well-being, not to mention the fact that preventative health measures and social inclusion will be enhanced through better communication linkages between family members and friends, especially for the housebound or isolated.

Ubiquity is important

Only two things hold us back from realising the potential. The first is that within health and community services we need to re-examine the current business models and incentive structures across the sector to facilitate different ways of doing things. Second, the example of eHealth has some important implications for the way we think about broadband infrastructure.

First, ubiquity is important. We can create institution-to-institution links now, but we need extensive household coverage to realise a truly citizen-centric and cost-effective health system. We also know from experience that networked solutions only take off when there is a tipping point in the level of penetration. The more people are linked in, the more beneficial the system becomes for everyone. That is why is it useful to focus on applications that can drive take-up and use.

Second, e-health and other like examples highlight the need for the high capacity symmetrical bandwidth that fibre links facilitate. Present copperwire and wireless-based solutions are predominantly built around an asymmetrical model where there is far greater download capacity than upload.

Finally, thinking about the uses we could make of broadband infrastructure reminds us that - to assess the benefits, and costs - we need to look at the value proposition across the whole service delivery architecture, not just the costly infrastructure platform.

The Australian Government is committed to broadband communications, it is committed to better health outcomes, it looks to better environmental management, and it is promoting more efficient energy systems. This provides an opportunity to join the public policy dots and to bring forward significant public benefit outcomes.

Dr Terry Cutler FTSE is an industry consultant and strategy adviser in the information and communication technology sector, Principal of Cutler & Company and Deputy Chairman of CSIRO.

This article first appeared in the December 2010 issue of Australian Academy of Technological Sciences and Engineering (ATSE) Focus. Reproduced with permission.