Georgia Partnership for Telehealth Waycross recently won a 2010 Broadband Technology Opportunities Program (BTOP) award worth nearly $2.5 million for its TeleConnect Georgia for Better Health (TCGBH) program, which builds out broadband networks to support telemedicine applications in underserved and rural areas. The partnership will match some of the grant funds in order to connect via broadband 1,575 primary-care physicians, 6,000 nurses and 700 non-physician practitioners in 91 counties, said Lloyd Sirmons, TCGBH's BTOP project director.

Georgia ranks near the bottom in the U.S. in terms of overall health, according to a 2008 University of Georgia — Atlanta study, and 91 of the state's 198 counties are in persistent poverty (20% or higher poverty rates), according to census numbers. To serve that population, TCGBH has been building a broadband network throughout Georgia's rural areas to carry telemedicine applications and health-education campaigns to the state's underserved populations for the last five years, Sirmons said. In the past, he said rural patients may have had to drive hours to be seen by a specialist. The buildout of a broadband network means doctors operating on the network and patients visiting connected clinics can be examined virtually via live video conferencing — saving both time and money.

"Via telemedicine, rural Georgians have access to modern medicine right at their fingertips," Sirmons said. "A patient needing to see a cardiologist in a small rural town, who may not have had the access unless they drove hours away, can go to a local doctor's office that has one of our telemedicine units and be examined by a specialist located in a nearby city, like Atlanta."

Reliable bandwidth for running high-definition video is needed for telemedicine applications, Sirmons said. And while wireless may be an option for some healthcare campuses, it would take robust internal networks to support applications, IT personnel to manage it and commercial carriers to evolve before wireless trumps wired telemedicine connectivity.

"Wireless technology in the past has not been strong enough to support live video conferencing," he said. "But things are changing. Right now, Verizon offers 3G. But in December it will be going to 4G, like Sprint. So what we are finding is that wireless technology is beginning to catch up."

As a result, the BTOP grant will let the organization continue to build out T-1 lines to service telemedicine applications, including expanding its current telehealth broadband network from 133 access points to 197 access points. Jerad Johnson, TCGBH's BTOP IT administrator, explained that it is an open access network built using dedicated T-1 lines leased from regulated telecommunications carriers in the state of Georgia.

"It is a private, dedicated network that uses point-to-point dedicated T-1 lines," Johnson said. "The line is used for its security and reliability, with a guaranteed bandwidth that is always available."

Johnson's team is in the process of upgrading the network by adding a 40-bit Internet pipe. He hopes to move away from private dedicated connectivity and towards using the Internet as the backbone in order to save money. For example, a facility would use existing Internet infrastructure but must have quality- of-service control (QoS) installed at their gateway point.

"They would need to slice off dedicated bandwidth that would be used for telemedicine services, because the real-time video portion requires guaranteed bandwidth," he said. "They can't be sharing with network traffic, like e-mail or competing with the video portion."

Video conferencing aspects of telemedicine require broadband for guaranteed throughput, minimum latency and controlled jitter, Johnson added. As a result, most systems are hardwired, not wireless.

"On a hardwire install, you have more of an opportunity to guarantee 100-Mbps network and each device has that true connectivity; whereas in a 54-Mbps wireless network, you are sharing that amount of bandwidth between all of the devices," he said. "So a hardwired Ethernet connection would always be preferred."