Healthcare and fast networks

I've written about this before in a different forum, but that was ages ago and it still holds true.

People thinking that fibre isn't necessary for telehealth don't understand just how many kinds of applications there are, and the truly vast scale of the data that can be produced.

If you live in any reasonable suburb, there's a fair chance that it has a medical imaging joint servicing the local GP. There are more than 200 in greater Sydney, Google tells me – and most of these aren't in the lousy-with-fibre streets near major hospitals. They're in suburban high streets or the upper levels of ordinary shopping centres.

Go and get a CAT scan, look at those images, think how many there are if you've got lots of pictures in the scan, and take a guess at the amount of data there is. Individual images – depending on resolution – might range from 60 MB to multi-GB per image.

Which is why you go back to the joint to collect the images, go home, and then drive to your GP to deliver them.

Which is why, because the private imaging joint I have in mind didn't have a fibre link to Royal Prince Alfred hospital, I once found myself asked by a specialist treating my wife to walk to the place, pick up the DVD, and return it to him as quickly as possible, since they needed the images for a procedure due to start in 20 minutes.

It's sneakernet, sometimes with cars, all because there isn't fibre.

Now, consider this in economic terms – by which I mean stuff like productivity and unnecessary travel.

This report tells us that per 1,000 head of population in 2009-2010, there were 816 imaging procedures. For 22 million of us, that means there are nearly 18 million imaging procedures taking place.

Let's assume that just 25 percent of these happen in the suburban imaging service – 4.5 million. And let's assume a standard model, with all trips being 1km each way at an easy-to-calculate 50c per km:

1. Trip to GP to get referral for imaging
2. Trip to imaging centre for imaging
3. Trip to imaging centre to collect images
4. Trip to GP to deliver results

If the images can be delivered directly from the centre to the GP, the travel is reduced by 25 percent. Each year, in other words, connections suitable for lots of gigabytes would (in this very simple model) save 9 million kilometres of unnecessary travel.

That's nearly two billion tons of carbon, not to mention the cost of the travel, and there's the productivity cost to be considered. If you include time hanging around in the waiting room, those 4.5 million trips could easily represent a couple of million hours of unproductive time.

Even that's only $50 million a year, if we assess a productive hour as being worth $25. Plus (say) $9 million in travel. But get this: it's $59 million a year, probably rising – and it goes on forever. There won't be a year in the future in which there will suddenly be no medical images created.

And that's just one fibre-medicine opportunity. There are others, and every single one of them delivers real-money benefits.

If you try to imagine “telemedicine” as a single monolithic entity, you're missing the real point. Medicine – in any form – involves a huge number of different interactions, and many of those interactions are some kind of “sneakernet”. It's just that it's not easy to write a single article, or post a single video, that explains all the interactions.

“But you don't need to transmit that much data!” isn't an argument, it's a reflex built from a simplistic understanding of the billions of interactions involved in healthcare that get better with better connectivity.

Mythbusting: The Daily Telegraph was not handed out at Fox Studios for the Coalition's broadband launch

Here's the conspiracy theory: the evil Murdoch plan for the NBN is proven because at Fox Sports, in April, instead of a press pack, journalists were handed copies of the Daily Telegraph.

For example, from Twitter:

“Coalition Fraudband launch at Fox Studios and reporters handed details in a @dailytelegraph but no Murdoch conspiracy says @TurnbullMalcolm”

It didn't happen, and the reason I can say this is simple: I was there. I'm an eyewitness. I wasn't actually invited, in fact I regard it as one of the best press conference gatecrashes of my life, but I was there, since before Messers Turbull and Abbott arrived until after they left.

I still have the notebook I was carrying – the one I'm whacking with my pen when I'm asking Malcolm Turnbull questions in the press conference in this video, and don't I wish I was better dressed that day!

So this is a combination of my memory, and my side-notes about the sequence of events.

Yes, there were press secretaries there. What were they doing? Mostly, lining up vision with the TV producers: scribblers like me got to be bystanders. I got to watch events with nobody in my face.

So there was the exit-the-car shot, someone asking for a second go at opening the door, and Malcolm Turnbull and Tony Abbott walking through the foyer.

No Daily Telegraph handouts.

Then the cameras rolled while someone from Sky did the show-and-tell for Tony Abbott. I could almost sympathise with a politician in this situation: it was entirely so the TV news could show Mr Abbott nodding at bits of technology, no sound.

No Daily Telegraph handouts.

And after that stuff – still without Daily Telegraph handouts – was over, we took our places in the studio used for the announcement and waited, because the two VIPs needed to be given clear air entering the studio for the cameras. No Daily Telegraph handouts.

After that, there was a brief demonstration of a 3D hologram for Tony Abbott and Malcolm Turnbull (that would need a lot of bandwidth, which is odd as supporting material for a “25 Mbps is good enough” press conference).

And there was the press conference, and a handout at the end – without a Daily Telegraph. I still have the press pack on my desk, because I refer back to it when looking at Liberal Party policy announcements. I have it in its entirety.

The Daily Telegraph isn't there.

Was a Daily Telegraph story given to journalists? Yes: down in Canberra as a pre-launch puff to people who were not present at Sky Sports in Artarmon, Sydney.

Guess who else was not present at Sky Sports in Artarmon, Sydney? The bloggers and conspiracists who are convinced that the Daily Telegraph was handed to people like myself in lieu of a press pack.

How has this idea taken flight? Here's how:

1. The Coalition gave the Daily Telegraph an early exclusive on the story. It drives journalists nuts if they're not the ones getting the exclusive, but it's also completely unexceptional.

2. For some reason a press secretary in Canberra thought it would be a good idea to rub the rest of the Gallery's nose in the exclusive, by handing the story to other Gallery journalists.

This event is clearly documented by Crikey, here.

'Last Tuesday, journalists in the Canberra press gallery were eager for details of the opposition’s broadband policy, due to be announced later that morning. So they asked the Coalition’s spinners for information. Instead of a regular press release, however, the journos were handed a colour photocopy of that morning’s Daily Telegraph front page story. The headline: “Pledge to slash internet bills: NBN at half Labor’s price”.' (My emphasis)

This is clear and unambiguous: the Daily Telegraph “drop” was in Canberra, not in Sydney.

3. However, bloggers have put the two events together and decided that the newspaper was handed out at the launch in Fox Studios. For example, courtesy of “No Fibs”:

“The Coalition held its broadband policy launch at, wait for it, Murdoch’s Fox Sports, And the press secretary handed out copies of Murdoch’s Daily Telegraph instead of policy documents.”

It never happened. I was there. I have the press pack. Not The Daily Telegraph.

Why bother setting this down? Because conspiracy theories never made a debate work better.

Nutlessness as a service

Any tech journalist who discusses Malcolm Turnbull's "policy launch" tomorrow without quizzing him on it acting in the service of politics without the chance to examine the policy-maker, and is a fool.

Whatever else we know about Malcolm Turnbull's broadband plans, they represent brains without balls.

Brains tells us that everything you say about broadband in Australia is an attack launched on a government that can't take a trick, even with fourteen trumps in its hand.

Balls?

There once was a man from Devizes

Whose testes were two different sizes

The one was so small

It was no ball at all

The other won several prizes.

When it comes to a broadband policy launch, is Malcolm Turnbull winning prizes?

Don't make me laugh: he's keeping the gig to the morons, partisans, gourmands, time-servers, place-seekers, and dyspeptic dipsomaniac brain-donors of the press gallery.

Having handed a gift of a policy that's already risible – virtue of its red-handkerchief $90 billion – to a witless goon at the Daily Telegraph, Mr Turnbull is now ignoring every approach to journalists with, you know, experience in the telecommunications market.

He's quite free with his advice, criticism and public denigration of journalists that don't agree with him. I've had “why won't you call British Telecom?” (answer: I did) and is happy to tell me what I've misunderstood, forgotten or added up wrong, should I dare to run a spreadsheet over the NBN or any similar project, anywhere else in the world.

I've offered to quiz him at any public press forum he chooses, and never once received a reply.

With 25 years experience in writing about the telecommunications industry, and – if I include my original training at the Overseas Telecommunications Commission – close to 30 years all up around telecommunications, I'm not on the invite list for Malcolm's Great Broadband Policy Launch.

Because, unlike the lazy shit-for-brains that infest the gallery, for whom all politics is reduced to “the government said / the opposition hit back” or “the opposition said / the government hit back”, I am both numerate and familiar with all of the technologies that are proposed for modern broadband.

In other words, people like me – and I have – need to suffer his lame lectures about journalistic technique if we don't agree with him. He'll sit at the door, scratching and whining like last decade's hound that we're not going to the original source (that is, sources that agree with him). But we're not permitted to quiz him in a public forum.

In his broadband launch, Malcolm is going to be an original source – but only if he can share his fleas with other superannuated hounds.

What a lame joke: and this is the best brain in the alternative party of government.

What a joke.

Work that “$90 billion” figure, printed without question, query or even the simplest mathematics by the Daily Telegraph, the utter suckhole of journalistic suckholes in Australia, a place even facts won't use as their hospice because it's better to die in the gutter than have your brains sucked out by News Limited lizard-people with skull-drills and straws.

On today's number of households in Australia, that's well past $10,000 per household.

That number is so stupid – strike that, so utterly stupid – that any journalist worth the price of the headline and a Starbuck's coffee should have asked even one question:

“Since British Telecom is only asking a couple of thousand per kilometre for individual node-to-home connections, on the most inefficient model that human ingenuity can devise, what idiot gave you a convincing estimate of $10k per household for FTTH?”

Or even better: “Why did you believe an estimate that is many times every available international benchmark for FTTH rollouts, based on what's already been spent?”

Or even better: “This is a naked political lie. Put up or shut up.”

News Limited doesn't work that way. Its game is this: we will only run with the naked, unadorned press release, if we get it first. Go off to its IT pages and tell me I'm wrong: but only if you first poll the PR companies who know how the game is played. Give News a 24-hour break; that's all you need.

And it can even be utter drivel as ran in the Telegraph today.

Which is why experts aren't going to be welcome at Malcolm's little piece of theatre. It only took a few seconds with a spreadsheet – but the brain donors don't do numbers, they do “he said / he hit back”. Which is exactly the wank-and-dribble level of intellect Malcolm Turnbull wants covering his policy launch.

The one was so small, it was no ball at all

About vectoring: Malcolm is almost right but not quite

“The fact of the matter is that the shorter the copper loop, the higher the speed you will get. There is a new technology, a noise cancellation technology called vectoring, which is now being deployed, which will literally double the speed. So if you had a line which was delivering 50 megabits per second now, with vectoring, which is just a software solution, it's not, you know, it's not expensive to deploy, you can then double that to 100 megabits per second” – Malcolm Turnbull to ABC Radio National (http://www.abc.net.au/radionational/programs/breakfast/malcolm-turnbull-on-changes-to-the-nbn/4557604 here).

“This is the folly of stipulating one particular technology at the outset. FTTN is a much more powerful, much cheaper, much better prospect now than it was four years ago.”

Damn: I have to try to look at vectoring in a bit more detail, because if you don't understand it, you won't see the pea under the thimble.

First, the line-by-line, then the technology.

“The shorter the copper loop, the higher the speed you will get” – Correct.

“There is a new technology, a noise cancellation technology called vectoring, which is now being deployed, which will literally double the speed. So if you had a line which was delivering 50 megabits per second now, with vectoring, which is just a software solution, it's not, you know, it's not expensive to deploy, you can then double that to 100 megabits per second” – here, Mr Turnbull gets things a little bit scrambled.

It's probably not his fault. The industry PR has done a neat job of wrapping vectoring in a superhero's cape.

“Will literally double the speed” – Vectoring will improve the performance to individual subscribers, but the results they see in the real world are subject to a lot of dependencies. "Can" double the speed would be more accurate.

“Just a software solution, not expensive to deploy” – Only if the equipment in place supports it. If you've rolled out a VDSL2 network, and it's new enough, then that might be true. You'll note in the example I refer to below, Austria's A1 Telekom, the upgrade involved hardware as well as software, which is much more espensive than a software upgrade.

Tl;dr starts here

I realise that there are people queued up ready to fire their “ALP stooge” guns at me. So here is a much more detailed explanation of my position.

Here is an excellent – and not too hard-to-understand – presentation from Ericsson. For the Tl;dr crowd, the main point is that vectoring exists to take care of a particular kind of noise, far-end crosstalk or FEXT.

If Bob and Alice are both DSL customers – any kind of DSL will do – and they're served through the same cable bundle, then each of them appears as “noise” to the other. That is, Bob's signal will couple to Alice's twisted pair, and since it's not Alice's signal, it's noise, and reduces the capacity available to Alice for communication.

The same thing, of course, happens to Bob: Alice's crosstalk cuts into his capacity.

However, the noise Alice generates is different to random electrical noise: it has some predictable characteristics, because you know it's a DSL signal that's generating the noise. That means you know (for example) which frequency bands will suffer noise, and that patterns that it will exhibit.

And that means – with good mathematics (if you want employment in mathematics, network physical layer work is a good place to start) – you can get rid of Bob's noise on Alice's line, and vice-versa. This is vectoring.

Bob, Alice, and World+Dog

If there were only Bob and Alice to worry about, vectoring wouldn't be a “new thing”. But every house connected through a twisted pair is connected in a bundle of cables. 

In a bundle of 48 cables, this would be unmanageable even with vectoring, if every cable coupled its crosstalk to every other cable. Fortunately, that doesn't happen. Lines will couple more strongly if they're close together. More importantly, some lines – for example, where copper degradation or damage spoils the line's impedance – will leak more noise than others.

Ideally, all crosstalk should be cancelled, but Ericsson's white paper notes that “close to optimal” performance can be achieved by concentrating on eliminating the noise from “dominant disturbers”.

And in the case of vectoring, “optimal performance” means the speed VDSL2 can achieve on a single line. “Vectoring” doesn't change the maximum speed available on VDSL2 – it lets more users get closer to that maximum speed in a crowded cable bundle. 

Vectoring in practise

In a presentation to the 2013 Broadband World Forum, Gerald Clerckz of A1 Telekom Austria gave a presentation outlining that carrier's experience with vectoring in its field trial in Korneuburg.

The implementation involved: 

• upgrading DSLAM line cards 
• upgrading the DSLAM software 
• upgrading modem firmware to support vectoring
• replacing modems that could not support vectoring.

A1 Telekom is pleased with vectoring, saying in the presentation that vectoring is “fulfilling the expectations” while also noting that “it cannot be seen as a replacement for FTTH”, but rather as a bridging technology on the way.

With that noted, there is a very wide spread of real-world outcomes achieved in the field trial. At between 250 and 300 meters loop length, customers on the trial experienced download speeds from around 120 Mbps down to around 35 Mbps; customers at above 400 meters experienced speeds between about 22 Mbps up to 75 Mbps. The poor customer at 600 meters was only able to get around 30 Mbps. 

I don't have permission to reproduce the original chart, but here are the extremes at different distances:

This, remember, is a real-world deployment, not a vendor's claim - and it's a set of data from a carrier that's happy with vectoring. It's a statistically valid sample, as well, since the test covered 500 homes, more than ten percent of the service area of the test.

What's clear, here, is that while vectoring can double speeds, there isn't much difference in the top-to-bottom envelope - and that diference evaporated at 600 meters (however, that may represent fewer data points). At 300 meters, the difference in best-case performance was 33 percent.

Will the coalition’s FTTN get people off dial?

This is odd: There’s a considerable gap between two different ABS measures of the number of dial-up Internet customers still in Australia.

According to the bureau’s Internet Activity, Australia, there were 379,000 household dial-up subscribers at the end of 2011. However, according to the Census data (collected in August 2011), there were only 235,000 households reporting themselves as dial-up Internet users.

I suspect that there are a lot of people who kept a backup dial-up account at some point, and who haven’t gotten around to cancelling it.

This is an aside, however. 

This post is in the context of Malcolm Turnbull's initiative to survey users on broadband speeds.

I was interested that Turnbull's concerns include the dial-up customer (which led me to notice the data discrepancy). To quote Tony Eastley’s introduction* in AM, “the opposition says close to half a million households still use dial-up technology, and they’re being forced to wait too long for the NBN.”

Given the speed of dial-up’s decline in Australia, I doubt it. The dial-up sector lost nearly 100,000 customers in the six months to December 2011 anyhow – if that rate is maintained, it will die of its own accord in a couple of years.

(I would guess that most of the remaining 90,000-ish businesses with dial-up accounts use them only for backup, by the way. That application is being replaced rapidly with mobile connections.)

My other point is best illustrated by a rough map:

This shows the Census SA1 areas in which more than ten percent of the households still have dial-up connections. I haven’t calculated exchange distances, but the illustration should tell you enough.

Dial-up is at its most stubborn in remote places – areas that would be the slowest, most expensive and difficult to upgrade to FTTN.

*Note: it's perfectly possible that AM misunderstood something Mr Turnbull said, but that the program didn't put to air. If so, my apologies to Mr Turnbull.