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.

Get the target right in the national security debate

I wish journalists would stop personalizing the national security proposals – the Cybercrime Legislation Amendment Bill 2011 – to Nicola Roxon, because I don’t think it’s helping.

Remember, for example, that the bill pre-dates Ms Roxon’s appointment to the Attorney-General post. It’s been around since the middle of last year.

Remember, for example, that whatever change has or hasn’t happened in Ms Roxon’s attitude, she won’t be in charge of the retained data. “Do you trust Nicola Roxon with your data?” is a lame question, even as a rhetorical device.

The reality is much, much worse: the data would have to be retained by telcos, not all of whom can be trusted with it. Australians think “Telstra, Optus, Vodafone, iiNet” and don’t realize the size of the sector – more on that later.

Finally: Remember that the proposals are supported by the opposition as well as the government. The opposition helped vote-down amendments proposed by Senator Scott Ludlam to try and protect Australians from having their data shared with countries that impose the death penalty.

If the lobbyists let the opposition off the hook in this debate, it will be a strategic error: a great deal could be achieved if the opposition were to take scrutiny of the bill seriously, instead of letting it through “on the nod” to protect its “strong on national security” credentials. But that’s not happening: instead, the focus is on the easy target.

Back to the scale of the telecommunications industry.

There are currently 191 licensed telecommunications carriers in Australia (according to the ACMA). There’s also more than 450 Internet service providers and more than 300 non-carrier voice services.

Under the government’s data retention proposal, all of these bodies would be required to store personally-identifiable and often sensitive information for two years.

Many of those 500-odd businesses (taking into account the overlap between carriers, ISPs and voice services) are too small: they won’t be up to the task of securing that customer data. I’d be much more worried about an easy-come, easy-go resale business leaking the data than Telstra.