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Seven years ago, Bob Crandall predicted broadband would produce $500B/year in savings, including perhaps $40B by growth induced in telemedicine. We can now test his assumptions against several years experience. Does evidence confirm the predicted explosion? U.S. broadband availability has been at over 90% for several years, not quite universal service. Telemedicine growth has been relatively limited in those seven years.

The editor of The Journal of Telemedicine and Telecare, Richard Wooten, writes “Sorry to sound like a damp squib. I would rather doubt that investing in broadband services will lead automatically to more telemedicine. That would mean that telemedicine is presently stifled simply because of lack of bandwidth, whereas most people feel that the barriers are more complicated than that, and are mainly due to organizational/people factors, and not due to a lack of technology. Things like changing the way that doctors work, and changing the ways that hospitals (and their finances) operate, are at the heart of bringing telemedicine into routine service.”

Original article from August, 2008. Updated Febuary 2009 with Crandall job comment.

The growth in telemedicine has been disappointingly slow. For example, Frost and Sullivan estimates the total European telemedicine market generated revenues of $118.0 million in 2007. I don't have U.S. numbers, but they a single digit fraction of $40B.

My interest was inspired when an expert in the field told me broadband isn't needed for 70-90% of home telemedicine. Some projects require video and a high speed connection, but not all. Most of the work is counseling patients by phone and recording simple readings like blood sugar and weight which can be sent over dial-up. For example, the new Sasktel/Alcatel monitors some data that could also go by dial-up, and many effective home projects are just a few measurements accompanied by questions and patient education.

Professor Wooten, co-author of several textbooks, adds, “most telemedicine work is done via leased lines.” Most clinics and hospitals have a high speed connection already, so growth in consumer broadband will add little. For example, one North Carolina boy no longer has to be driven 200 miles for his follow-up visits to a pediatric cardiologist. Instead, he goes to a local clinic, and the specialist examines him with some assistance from the local nurse. They are connected by a traditional T-1, not DSL or cable.

Crandall himself now believes many of the broadband job claims are "grossly exagerrated."

This is part of my project on “evidenced-based policy,” inspired by the work on evidenced-based medicine. I'm finding many of the same problems as the medical researchers, including significant “publication bias.” I'm looking at research that influences policy and deserves a closer look at the underlying evidence. Other questions I'm asking include whether broadband demand stimulation has a major effect on job growth; is traffic growth (exaflood) likely to outpace supply growth in bandwidth; whether USF should include “high-cost switching support” when today's switches are low-cost; whether wider deployment of broadband is economically unattractive; and can distance-based mapping identify those who can't get broadband. I welcome all help and advice, and am optimistic the work will find an academic home down the line.