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Friday, April 29, 2016
The Last Big Barrier To A Rural Renaissance: Healthcare

I’ve written before about the ways that small towns and rural areas can take advantage of broadband Internet connections to gain access to global economic opportunities, educational and cultural resources, even the virtual equivalents of coffee shops that used to be only available in big cities.

Perhaps the biggest remaining barrier to a 21st century rural renaissance is access to world class health care.    

With that in mind, President Obama’s Rural Council brought together about three dozen experts to the White House complex last week to identify innovative ways of bringing health care to the countryside and to establish a “community of practice” that will help the Obama administration and hopefully its successor to address the problem.  

The group included:

  • Federal officials from various agencies, including Secretary of Agriculture Vilsack
  • Leading broadband providers and the Rural Broadband Association’s CEO, Shirley Bloomfield, and Joshua Seidemann, Vice President of Policy (who helped organize this meeting)
  • Exemplary providers of tele-health, and
  • A couple of other experts, including myself (in my role as Senior Fellow of the Intelligent Community Forum and director of its New Connected Countryside initiative)

This “convening” was led by Doug O’Brien, Senior White House Advisor for Rural Affairs.

It was noted, although not news to those around the table, that the nearly 60 million Americans who live in rural areas were hit especially hard by the Great Recession.  Their local economies have taken longer to recover, still not back to pre-recession employment levels.

But the comparisons of rural versus urban health care were most striking.  Here are just some highlights:

  • Rural areas have higher rates of disease and higher mortality rates than urban areas. In 1980, the rural mortality rate was 2% worse than the urban rate and now it’s 13% worse.
  • While approximately one in six Americans live in rural areas, only one in ten physicians practice there. There are even fewer medical specialists per capita.
  • Suicide rates are higher and getting worse in rural areas. Along with a growing drug abuse problem, this is a reflection of a growing need for mental health services.

None of these medical problems are helped by the fact that rural residents are poorer and less likely to have health insurance.  Of course, given the lack of sufficient nearby medical resources, rural residents need to travel further – often hours further – than their urban counterparts.

In the Internet age, that last problem should be able to be mostly overcome with health care delivered remotely.  So most of the meeting was devoted learning about the use and deployment of tele-health care.  In this post, I won’t be able to describe all of them or any one of them in detail, but here are some that stood out to me:

  • Using cost-effective solutions, like iPads, Vanderbilt University Medical Center has established a network of rural tele-health services. This even includes virtual group sessions for people with drug addiction

The US Department of Veterans Affairs has pioneered the use of virtual ICUs in its rural clinics and facilities. With a fully developed set of tele-health tools, to the patients and local staff, it’s like having the expert ICU doctor at the bedside. As a byproduct of these virtual ICUs, the medical staff at these facilities are also getting an education in newer and better medical techniques.

Through East Carolina University School of Medicine, there is now a tele-psychiatry network in North Carolina. The relatively low cost of making tele-psychiatry available is helpful, given the increasing need for mental health services.

Obviously, many rural areas do not yet have the broadband which is necessary to deliver these services.  But there are clearly broadband providers, especially telecommunications coops, which are up to the task.  We heard about just two of those who had completed gigabit deployments to every household in their rural areas in Kentucky and North Carolina.  One of those, Peoples Rural Telephone Coop was reported on in a Daily Yonder article last month, “One of the Nation’s Fastest Networks Serves Two of Its Poorest Counties”.

Even before the recent recession, there were long term trends in rural America that called out for a different and new economic strategy.  In his closing remarks, Secretary Vilsack noted that, since 1950, agricultural productivity has increased a hundred fold on 27% less land and with 22 million fewer farmers.  So the challenge today is what opportunities and quality of life can the remaining families have.  

The people around that table last week and ICF believe that a revived rural community can be built upon the intelligent and creative use of technology – and improving access to quality healthcare is just one very important example.

 
Monday, April 18, 2016
Looking for Things Nearly Unseen but Real in a City

The major question Top7 host cities have before I set out to visit them is what I want to know. There is some anxiety on their part because they want to make sure that they do well in Columbus on June 16, but also because they want to show off their cities. There are also several people involved and a lot of coordination and, I’m sure, cost involved with a Top7 Site Visit. So I am sensitive to this and try to be a good guest and not make people feel like the Grand Inquisitor and Inspector General has rolled into town.

This year I have been chosen to visit New Taipei City (Taiwan) and Surrey (Canada). I am in New Taipei City this week. It is an interesting place on paper. It made the Top7 for the third consecutive year, which puts it on a trajectory to possibly follow a pattern set by Eindhoven (The Netherlands) and Columbus (USA), both of which were in the awards program three years before their number was called as the Intelligent Community of the Year. NTC interests me because it is by far the youngest city among our entire family of 145 cities, regions and towns. It was formed less than one decade ago from the 2006 Intelligent Community of the Year, Taipei. Mayor Eric Chu of NTC, who lost the nation’s presidential race this past year to Tsai Ing-wen, the nation’s first female president and the most powerful woman in the Chinese-speaking world, is the scion of one of the most powerful political families in Taiwan and has effectively birthed NTC and brought it into the world! It was born to privilege. NTC is a legitimately powerful economic engine. I know Mayor Chu and he is a very sharp guy, politically savvy and understands governance. While NTC has a massive tech base and much business, I am really curious to see if it has the shape and feel of a real “community” yet – and of course I want to understand how this is (or is not) happening.

When the Top7 plan for my visit, they always ask what I want to see and how the visit can be best arranged during the 48 hours that I am typically on the ground. The first part is simple: use the six ICF Indicators to guide the events and plan media around it so that you can maximize the global connection and honor.

The last part of the question, often not fully asked or understood, is to show me how you are going from technology to transformation. I always have a very simple image in my mind for this. It revolves around my 2003 moment with Blackberry co-founder Jim Balsillie. When I asked him why he chose to stay in Waterloo, Canada, he said simply, “This is where I live and where I want to live.” That’s good incentive. To live well you need more than connectivity.

A lot more. I will see what New Taipei City has that is making it more than a place with a lot of economic activity and a shiny new City Hall. More precisely, I will be looking for something intangible, or nearly, which is a sign of rebirth. That sign I will take back and share with you and the Jury. How’s that for a challenge?

 
Tuesday, April 12, 2016
Laws are constantly changed and rewritten, even in Texas

PART 2:  With smart infrastructure, smart people and smart money,
an innovation ecosystem is never too far behind.
    

As we see the emergence of the Internet of Things in the short years ahead we will become even more used to changes in how we will expect things to work and how differently we will want to do things. Resistance to change has been the usual excuse for communities and people, in general, in the past to accept new ways of doing things, but as our urban areas increase their populations and it becomes more difficult to be mobile; to be able to do the things that we may have done previously and we will now have to share it with more people waiting to have access to it, there will be less resistance to change. Perhaps even pent-up demand will be experienced for things that people see in other communities and expect will or should be available to them in short order.

Travelers to Europe and Asia have seen the efficiencies in road improvements from improved LED lighting to synchronized traffic lights and seamless border crossings; enhancements in the development of the bicycle culture; parking guidance systems; and enhanced transit digital information systems.

Needless to say, they come home and demand improvements to mobility for their communities.  With increased immigration and tourism, applications that had previously been deemed traditional in certain regions of the world are becoming more broadly applied on a global basis. Hence applications that were familiar in the streets of Taipei, such as the countdown to a red light in traffic intersections are now familiar in the streets of Toronto; foods that were customary only in Thailand are now nearly ubiquitous throughout North America and a solution aimed at solving a problem in San Francisco is now a global phenomenon.

While Uber has been fought by taxi drivers and governments in many cities around the world, an increasing number of millennials are influencing their peers and families to begin to use the service. Think of Uber not as another taxi service, but as a digital organism that has clinically solved a mobility problem in one area, but is like a living organism that can penetrate any region of the world; learn as it grows through constant feedback and other metrics, provides its host community with improvements to its mobility issues and convenience for passengers. It clearly disrupts a traditional economic ecosystem that had previously been immune to threats. In some communities, traditional taxi systems and governments that depend on their fees are fighting this digital organism from advancing, but many bet that it will eventually win over the local population. Uber is a concept more than a product or service. Uber is also now servicing the logistics and mobile transactions related to the food distribution industry such as deliveries of pre-made lunches and dinners destined to the working customers in office towers; it is servicing the logistics involved in growing e-commerce sales; and its ability to enhance the functionality of any mobile application ensures that any new application that comes along can easily be incorporated to further improve the experience for its users.

For instance, the trucking business in North America has been a fragmented and inefficient business for a very long time. Even with brokerage firms that charge large commissions, representing as much as 45% of the delivery costs, especially for short hauls, it is a world of 3rd party logistics, where fleets of independent, mostly small time operators with one way full loads make up the majority of movements. The top 5 logistics firms in North America only earn 20% of the overall revenues and according to the Economist (03/05/16), the entire logistics industry “is a juicy target, ripe for disruption”. Worth over $700 Billion in North America alone, it will only grow with e-commerce on the rise, and could significantly improve with apps and improved methodologies to travel with much fuller loads. According to Deloitte, 28% of the total distances covered, 80 billon KM, are empty shipments; an environmental waste and a huge opportunity for entrepreneurs and smart investors. Mobile apps that can make the trucking experience run quicker, cheaper, collected together to make them two ways full loads and more transparent are beginning to replace brokers.

Some startups have developed apps that mimic Uber by automatically matching drivers to loads; others scan for nearby empty or small load trucks; and others rate the driver’s past performance and availability. Truckers themselves can use apps to help them find potential loads to fill their trucks. Warehouses and shipping firms like LogiKor consolidate loads before they are shipped. But smaller and high value shipments are now being tested by Uber as taxis are being used to deliver parcels when they are not delivering people; Google is testing apps that move parcels via bicycle lanes and sidewalks; while Amazon has tested apps that deliver their parcels via drones. Driverless trucks are also on the horizon.   

Communities around the world are creating startup ecosystems to build on the ever growing demand for innovation. Where once traditional industries once puffed out fumes from its chimneys, home grown tech startups now carve up their brick and beam spaces developing software and applications for domestic and possibly global consumption. Enter maker spaces and the high demand for disruptive technologies to make things, locally via laser cutters, 3 D printers, shared equipment and software, and the benefit of elder mentors at the table beside you.

Intelligent Communities are more than simply the efficiencies and cost effectiveness of moving goods, services and people; it addresses the transformation and evolution of cities, towns and regions through education, sharing of information, benchmarking and encouragement to look beyond and from a more holistic perspective. What are the implications of these disruptions; are there ways to even further improve the health, security and quality of our lives through enhanced opportunities in education, the economy and our cultures? How can we ensure that the benefits of these applications and new ways of doing things ensures we manage our environment for the betterment of lives and those of our children and their children? How can we ensure that all of our citizens can benefit from this prosperity and allow them to also fully contribute and participate in our societies? And how can we be sure that we are making decisions that all can agree on and collaborate together on for our collective and mutual benefit? At all levels technology can help to enable, not dominate our civilization to prosper and grow. However, we will need to be vigilant that our security, privacy and opportunities for growth and prosperity are protected and maintained as we continue to disrupt the way we do things and allow them to disrupt us along our normal everyday path.

 
Monday, April 4, 2016
Laws are constantly changed and rewritten, even in Texas

PART 1:  Disruption - to transformation - to evolution: the circle of life continues.    

As I move through my day, I am constantly disrupted in my normal ways of doing things to the point where I am no longer disrupted but maybe only annoyed that what I am now doing on a regular basis is the new normal. Then I become resigned to this fact and don’t expect to ever go back to what I had been doing years before. I begin to see the advantages of what I am doing today and would never wish to go back to what I had been doing. I even advocate the fact that this new thing is so much better and encourage others to do the same. As society accepts these acts by me and others, they become normalized and the disruption is no longer ever thought of as a disruption. Besides a new disruption has already taken its place. 

Through Open and Big Data and its associated analytics, everything can be tested and is up for grabs. While monitors, such as cameras and sensors are measuring everything from traffic movement, to air quality and the vulnerability of a water pipe to burst, risk managers and budget chiefs and their planners and engineers will be actively plotting out further improvements to efficiencies and cost effectiveness in a well-run smart city. Eventually with the right algorithms even many of these human interventions could be replaced implementing the promise of the Internet of Things to its fullest. But this effort is not to replace people and decisions to be made by them; just to streamline and provide evidence-based information so that people have all of the data and analysis at hand to make the best decisions possible.

Use and application of high-speed broadband has always hindered market forces to advance the delivery of services to some communities, especially in less dense small town and rural areas. Incumbents carriers have been criticized for not investing in marginal areas, forcing some municipalities or special interest groups to bootstrap services through collaboratively aggregating market demand and using ingenuity and often duct tape to jerry-rig temporary technology solutions until a proven business case exists to warrant a professional service to take it over. The last few decades saw many of these efforts in communities desperate to continue to exist by becoming part of the new broadband-based economy. A significant reason for the exodus to urban centers has been for jobs and opportunities, many of which have become based on the uses and applications that broadband services provide or relate to. However, there is now a growing trend to provide services further out to rural and even to remote communities through delivery of fixed and wireless broadband. While it may not be enough to stem the tide to the growing urban centers estimated to hold 70% of the world’s population by 2050, the Intelligent Community Forum developed a focus on the “rural imperative”, encouraging rural and remote communities to develop broadband based ecosystems that will help in their quest for survival and even prosperity in the face of this growing exodus to urban regions. Increased awareness of the desire for families to grow their businesses and educate their children in these small town and rural communities, might offer the business case for some companies and investors to provide an increasing opportunity for business, education and entertainment opportunities in these areas. Even these communities can contribute to the innovation and creativity spectrum of society as a whole while maintaining their traditions, cultures and way of life. Stemming the tide – even a little- to this massive growth in urban regions would be a major disruptive innovation in its own right that we should perhaps all be getting behind!

Innovation and creativity comes in many forms. We are primarily familiar with the arts and crafts; living arts such as film, music and performance; the creation (invention) or innovation of products and services; and the ability of successful applications to spawn whole new industries that can impact the evolution of a community into entirely new economic directions. Clusters of industry innovation, utilizing the sharing economy and the emergence of deregulation in areas previously heavily regulated are all disruptive in the way we have been doing things and expecting the way it will be done. Even the way in which they are being done is not as expected. Uber, for instance, is not only disrupting the taxi industry, but is doing so without owning any vehicles; Airbnb is becoming one of the world’s largest overnight rental agency without owning any units; and Millennials are changing the habits of those around us by favoring a better smart phone than a better automobile, or none at all by walking, biking or taking transit instead. We have become more used to things monitoring us such as cameras on streets and in buildings and spaces where people commonly collect or move through. Our smart phones, credit cards and even our smart TVs and GPS in our automobiles collect data on our everyday activities. Sure, we are concerned about privacy, intellectual property and protecting our rights, but there is evidence of a growing change in people’s perceptions, behaviors and expectations related to things over the Internet.

Take file sharing for example. Napster was such a big issue when it first emerged. “Piracy” was a bad word. Today, we seldom hear the word piracy; since we have “file sharing”.    

As Robert Steele, President and COO at Rightscorp explains: “In speaking with people both inside and outside the entertainment industry over the last few years, I’ve been fascinated with what appears to be a general consensus that internet piracy isn’t the problem it once was.  When I tell people that I help protect artists’ rights on the internet and collect payments from people who are file-sharing music and movies without permission, people often say, “hasn’t streaming eliminated piracy?” or “I thought they shut that down?” or “didn’t they get sued?” When I mention that file-sharing in North America has grown 44% from 2008 to 2014, I often get silence as the response, or “hmmm.”

He explains further that people have progressed from Napster “outrage to fatigue, then to resignation, and ultimately to acceptance and its cousin, denial”.  While more people are beginning to pay for copyright services such as Spotify and Netflix, file-sharing in North America is still growing in North America (44% since 2008). Global growth has increased 80% between 2008 and 2014, but there are signs of encouragement in Europe where there appears to be a decrease in piracy emerging, despite the fact that European piracy is nevertheless still nearly 50% higher than in North America, even after 4 years of decline.    

 
Monday, March 28, 2016
Is this the Golden Age for the World’s Small Places?

Today, the 50 most prosperous cities in America produce 34% more economic output per person than the national average.  Their populations are growing at 3 times the national rate.  That’s because they are magnets for ambitious and talented workers and the companies that need their services to power growth. 

These statistics come from the US, courtesy of The Economist (“The Great Divergence,” March 12, 2016).  But the same phenomenon is evident every place there is an industrial or post-industrial economy.  In the words of economist Tyler Cowen of George Mason University, “average is over.”  The question for mayors, city managers, members of council and concerned citizens is this: on which side of “not average” is your community going to be?

You can get a good idea by looking around you.  Is your community a place where new businesses and new industries get a strong start, with the help of partners like universities and community colleges? Do your citizens have the skills needed to power prosperity?  Does your government partner creatively with business and institutions to help them grow?  Are you looking after the people who have been left out of the digital economy?

If the answer to most of these questions is “yes,” your community is above average. If not, you have every chance to get there, whatever your community’s size, location or history.  Because broadband has become the great economic leveler of our time.  As James Fellows documents in the March issue of The Atlantic (“How America is Putting Itself Back Together”), small cities in the middle of nowhere are becoming hotbeds of company formation. 

The small places of the world that are robustly connected can be global competitors, whether they are Redlands, California (home to ESRI, the world leader in GIS) or Duluth, Minnesota, which has become one of America’s aerospace centers thanks largely to the two brothers who founded Cirrus Design.  They are places where people want to live for the sake of the place, not just a paycheck.  And they have one enormous advantage over tech hubs like Silicon Valley, Austin, Boston or New York.  Land is cheap.  As Mr. Fellows puts it, ‘Every calculation – the cash flow you must maintain, the life balance you can work toward – is different when a nice family house costs a few hundred thousand dollars rather than a few million.” 

For more than 15 years, ICF has dedicated itself to learning from above-average communities how to turn broadband into economic opportunity, social progress and cultural richness.  Now that the evidence is rolling in , we are here to teach the principles, measure your results, and celebrate the victors through our annual Intelligent Community Awards.  Welcome to the Intelligent Community movement.  

 
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