Chapter 3. Telecommunications and Rural Support Services
Background
It is beyond the scope of this study to do an in-depth survey and assessment of the use of telecommunications services and technology by the services supporting the rural sector. However, an indication of the way in which technology is being applied by some of the support services for rural populations, and the implications for future rural telecommunications infrastructure requirements, was obtained.
The two areas where useful information was gathered through unstructured interviews and e-mail surveys were libraries and health services.
Libraries
An e-mail survey of a small number of rural or provincial libraries was conducted using a recommended mailing list on the web.
From the list of addresses sixteen rural libraries were subset, and an email sent requesting their participation. Of the 16 libraries surveyed, 4 (25%) responded. The full text of the questions and answers received are in Appendix IX: Rural Support Service Information.
It is not possible to draw well-founded conclusions based on this number of responses, but some general comments are in order. Libraries are, in general, offering Internet access services, usually in the form of one public access point. From the information provided, this service is in use from between 2-3 hours and 5-6 hours per day. There are seasonal differences attributed to school holidays and tourist use. In this capacity, libraries seem to be a cross between a traditional library offering access to information (albeit through a new medium) and an "Internet Cafe" for general e-mail and recreational usage.
Each of the libraries responding has a charging scheme in place with access being charged at $6-8/hour. The need for cost recovery, which is different from the cost recovery associated with information contained in books, was commented on.
There are hints that the role of the librarian may possibly alter with respect to Internet accessed information, as the librarian appears to have less of a hands-on approach than in a more traditional information search where the librarian may be asked for input. This, no doubt, is an issue that transcends the urban/rural split.
The access speed problems mentioned by the responding librarians appear to be the "normal" slowing associated with peak use times, and are considered to be more an ISP problem than a telecommunications service issue. Other than one library, none seemed to have significant access problems associated with lines and there was uncertainty whether that one was in fact a lines problem. This is not unexpected given that libraries serving rural areas are still inside the telecommunications infrastructure of towns.
Telecom (2000b) has suggested public Internet access through public institutions as a substitute for rural on-site Internet access as one way of overcoming future rural infrastructure problems. Given that 50% of respondents state they already have Internet access at their rural residence or rural business, it is unlikely that public Internet access points could provide an adequate substitute for existing rural on-site access use. From the limited information gathered here, public Internet access points do appear to be offering a useful service to the rural population who likely do not otherwise have Internet access, though 2-6 hours per day of public access at each library is a very small contribution to total Internet access usage. Telecom estimates Internet usage at 12.4 billion minutes per year nationally (207 million hours) (Telecom, 2000a).
Health
A conference held approximately 8 years ago in Wellington highlighted the potential for TeleMedicine, and its sub-disciplines including TeleRadiology, to improve rural health care. This conference largely focused on the rural health tele-network established around Texas A&M University and was run as a means of establishing interest in New Zealand, and moving beyond the few ad hoc trials that had been run up to that point in New Zealand.
TeleMedicine is essentially about using telecommunications technology to extend and leverage the expertise of medical specialists by making their expertise available at a distance for consulting, and by bringing information back from de-centralised locations to a central location, where specialist technical and medical support services are available.
By definition, rural New Zealand may be low in population density, but for the most part the distances to be covered to reach a major population centre do not equate to larger countries such as the US or Australia, and hence the economics of TeleMedicine relative to treatment at provincial centres are likely to be different.
Overall, it was difficult to find much interest in TeleMedicine within New Zealand. Such information as was available is summarised in Appendix IX). Within the time frame available, no information could be obtained from the NZ Medical Association and the Ministry of Health. (MAF Policy is, however, aware of a private venture proposal currently under discussion with Government, to incorporate
Telemedicine capability into a mobile surgical and telemedicine bus. This service, if introduced, will use a range of phone and satellite communication services to access New Zealand and overseas medical specialists during the course of its operations).
Staff at Timaru and Dunedin Hospitals involved in the South Island TeleMedicine trial were interviewed informally over the phone. They confirmed that the trial they were involved in was mainly hospital-to-hospital, and used frame relay networking for high speed movement of information. Some network congestion was reported, principally through the afternoon.
The summary of TeleHealth in New Zealand is best given by the web site of the Australian New Zealand TeleHealth Committee whose web page on New Zealand TeleHealth activities is reproduced in full. (Australian New Zealand TeleHealth Committee, 2000):
"Most public hospitals have videoconferencing capabilities. Those without are generally looking to develop capabilities.
Videoconferencing
Most videoconferencing equipment is currently used by hospitals for administrative reasons. Uses range from management meetings, to interviewing overseas applicants looking for a job, to keeping in contact with satellite sites.
However, some videoconferencing is beginning to move into more clinical areas. For example, use for continuing medical education, peer support and postgraduate training.
TeleMedicine:
Real-time TeleRadiology is the most widespread telemedical service. This usually involves a radiographer taking an image, it is then scanned (digitised) and sent to a radiologist for an immediate opinion.
There are few telemedical services operating which are based on a patient being seen by a distant health provider in real-time; examples include teledermatology (Waikato), telepsychiatry (North Auckland), and telepaediatrics (West Coast-Canterbury).
A number of extensive TeleHealth networks are now being developed. For example, the New Zealand Tele-Paediatric Service and the South Island TeleMedicine Project. These initiatives are investing in infrastructure (system hardware, and networks), and developing cultural practices of clinicians and patients with regard to TeleMedicine and telecommunication in general."
In summary, the implication is that New Zealand is only just beginning to really explore the use of telecommunications-based technology in the delivery of health services. It is questionable whether the copper-wire network structure will be adequate for practical TeleHealth applications which extend beyond provincial centres.
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