Tag Archives: access

Reviews

Internet access in Romania still much better than USA

Remember this article of mine, where I shared my thoughts on why broadband speeds are so far behind just about every other country in the USA? Well, the difference has just gotten even greater.

A little under two months ago, I helped my parents in the US upgrade their broadband from AT&T’s unreliable and slow ADSL to Comcast’s digital cable. This means they went from speeds of 2-3 Mbps down and 512 Kbps up (with AT&T) to 15-16 Mbps down and 3-4 Mbps up with Comcast. That was a huge improvement, but it’s still nothing compared to what is available in Romania at the moment.

Here, Birotec (my ISP) has increased their broadband speeds ten-fold this month. That means I just went from 3 Mbps to 30 Mbps. We went by their store today to pay our bill, and while talking with the customer service rep, I found out about the upgrade. She said it quite matter of factly, as if it was no big deal. It’s a huge deal to me! With Birotec, I can get speeds up to 100 Mbps if I want to. And the broadband speed is almost symmetric upstream and downstream, because it’s built on a fiber optic backbone. I went to speedtest.net and tested my speed today. I’m getting even greater download speeds than advertised, which is amazing. I get speeds up to 54 Mbps downstream!

Do you want to know the best part? It still costs me only €10/month for all this blazing speed, and I get a free telephone plan thrown in as well, with my own number. In the US, it costs my parents over $50/month for internet access with Comcast, and if they wanted a phone plan, the price would go up by another $30-40.

Romtelecom, Romania’s largest telephone and internet provider, has also increased their broadband speeds. They’ve begun using a new DSL technology called VDSL, and they’re offering broadband plans at speeds up to 30 Mbps downstream and 6 Mbps upstream. Incidentally, their largest plan (30 Mbps) also costs about €10/month, but you’ve got to keep in mind it’s still DSL and the uplink speeds are slower. Plus, phone service will cost you extra.

I’d love to know which companies can offer the same speeds in the US, and at similar prices. Short of Verizon’s fiber optic network, which is only deployed in limited metro areas, and still costs more, what else is there?

And that begs me to repeat my original question: why are broadband speeds so slow in the US?

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Thoughts

Republicans move to block net neutrality

The latest push to get the net neutrality bill passed met with resistance from Republicans and Comcast, one of the large American ISPs. Apparently they think the market regulates itself. It would, in a perfect world, but not in one where politicians working hand in hand with ISP lobbyists move to block any measures that would encourage real competition and require increases in broadband speeds, which is what the US politicians across both sides of the aisle have been doing for the past decade.

Is it any wonder then that broadband internet still sucks in the US? I say 5 Mbps broadband at $20/month or less ought to be legislated as a minimum, and all ISPs ought to be forced to offer it as one of their monthly subscription options. That would teach them a lesson they deserve.

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Thoughts

It’s no surprise broadband internet sucks in the US

A recent Akamai survey, which I shared here and here, ranked US in the 33rd spot (globally) when it came to broadband internet connections above 2 Mbps. Sure, it moved up two spots compared to last year, but it’s still lagging behind countries such as Monaco, Slovakia, South Korea, and believe it or not, Romania — which is where I’m living these days.

That’s sad. It’s very sad because a country such as Romania, with fewer resources than the US, and with a LOT more corruption at every level, has managed to provide better Internet services than the US. It just goes to show you how much pork barrel legislation and ridiculous lobbying can slow down an entire country’s Internet access. Why, every time a company tried to improve the way broadband worked in the US, it was eventually bought out or dragged down and kept down for the count.

Remember Telocity? It was one of the first companies to offer DSL service in the US, ahead of Ma Bell. Even though it was paying hefty amounts of money for the right to transport Internet traffic on Ma Bell’s lines, they had enormous problems with the same Ma Bell, due to problems that would somehow just happen to crop up on the same wires or the switching equipment. Then they’d have to pay more money so Ma Bell could fix their own equipment, which they’d say Telocity broke, etc., ad nauseam, and so on and so forth.

That’s just one example. Another was the more recent push to restructure the way cable services are provided (both TV and internet). One of the efforts was the a-la-carte programming initiative, and another was the push for faster and more reliable cable Internet services. You wouldn’t believe the advertising, PR and lobbying blitz the cable industry started and kept up for several months — actually, I’m fairly sure you saw their ads on TVs and buses everywhere, particularly in the Washington, DC area.

Or what about when they got together in late 2007 and 2008 to ask for an Internet tax? Remember the tiers of traffic they wanted to create? They wanted all the big websites to pay them for the traffic, as if they weren’t already getting enough money from the customers for their slow and unreliable services. They also wanted large chunks of money from the federal government in order to upgrade their infrastructure. No matter how much money they make, they’re so greedy they always want more, more, more.

What I’d like to know is how all these other countries, including Romania, can manage to offer faster and more reliable Internet services without asking for money from their countries’ government, without charging big websites for their traffic, and also by charging less per month for better broadband? How is that possible? Could it be that these companies actually know how to run their businesses while their counterparts in the US are filled with lazy, greedy idiots?

I still vividly remember an incident which happened while I was a director of IT at a Florida hospital, several years ago. A BellSouth technician had been called in to check the phone boards, and my network and servers kept going down and coming back up. The Medical Records system kept giving errors when employees wanted to access forms to fill in patient data, not to mention that other network services, like file sharing and printing, kept going on the fritz. I checked every one of the servers and they were fine. I finally walked into the switch room, at my wits’ end, only to find the moronic BellSouth employee with his fat, lazy butt on our UPS, jiggling it back and forth as he chatted with someone back at BellSouth HQ, plugging and unplugging the power supply that fed one of the main network switches. I went ballistic, grabbed him by the collar and threw him out of my switch room. Was he that stupid that he didn’t know where he was sitting? Was he such a pig that he couldn’t feel the plugs underneath him as he sat on them? He didn’t even want to apologize for taking out an entire hospital’s network during daytime hours. That’s BellSouth for you.

I don’t know how the US can get better broadband, unless it’s legislated. An ultimatum must be given by the government, one that can’t be overridden by any lobbyists or CEOs shedding crocodile tears in front of Congress. These companies simply will not get their act together until they, too, are grabbed by their collars and shaken about. They’ve gotten used to the status quo, they like it, and they’re clinging to it with all their might.

Meanwhile, here’s a sample of the Internet plans you can get in Romania right now. For comparison purposes, 1 Euro is worth about $1.4 these days.

Romtelecom (the main phone carrier, provides ADSL services):

  • 2 Mbps, 2084 kbps/512 kbps, 4.88 Euro/month
  • 4 Mbps, 4096 kbps/512 kbps, 7.02 Euro/month
  • 6 Mbps, 6144 kbps/512 kbps, 9.40 Euro/month
  • 8 Mbps, 8192 kbps/768 kbps, 14.16 Euro/month
  • 20 Mbps, 20480 kbps/1024 kbps, 24.87 Euro/month

[source]

Birotec (provides fiber optic services, all plans include phone line with varying amount of minutes based on plan price):

  • 3 Mbps up/down, 10 Euro/month
  • 4 Mbps up/down, 15 Euro/month
  • 6 Mbps up/down, 20 Euro/month
  • 8 Mbps up/down, 29 Euro/month
  • 10 Mbps up/down, 49 Euro/month

[source]

RDS (provides fiber optic, cable, cellular modem and dial-up access — prices not readily available on website):

  • Fiber optic access up to 2.5 Gbps
  • Cable access up to 30 Mbps

[source]

The lowest internet access plan in Romania is 2 Mbps. Cellular modems are advertised at speeds up to 3 Mbps. Meanwhile, in the US, you can still find 512 Kbps plans at prices twice or three times as much as the 2 Mbps plans in Romania. That’s the price of complacency and excessive lobbyism.

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Reviews

Google Health is a good thing

When it launched a few weeks ago, Google Health received fairly lackluster reviews. Privacy issues and lack of features were the main complaints. Well, I’m here to tell you those initial views are wrong.

Even if you’re a long-time reader of my site, you may not know what qualifies me to make that statement, so let me tell you a bit about myself.

My background

A few years ago, I was Director of Health Information Systems at a South Florida hospital, where I implemented an electronic medical records system. My job was fairly unique, because I not only wrote the policies and procedures for the system and oversaw its implementation, but I also rolled up my sleeves and built the various screens and forms that made it up. I, along with my staff, also built and maintained the servers and databases that housed it.

As far as my education is concerned, I hold a Master’s Degree in Health Services Administration (basically, hospital administration). I was also admitted to two medical schools. I ended up attending one for almost a year until I realized being a doctor wasn’t for me, and withdrew.

For plenty of years, I’ve been a patient of various doctors and hospitals, as have most, if not all of you, for one reason or another.

Furthermore, my father is a doctor: a psychiatrist. He has a private practice, and also holds a staff job at a hospital. My mother handles his records and files his claims with the insurance companies, using an electronic medical records system. I get to hear plenty of stories about insurance companies, billing ordeals, hospitals and the like.

So you see, I’ve seen what’s involved with medical records and access to said records from pretty much all sides of the equation. Again, I say to you, Google Health is a good thing, and I hope you now find me qualified to make that statement.

The benefit of aggregation

Just why is it such a good thing? Because I wish I could show you your medical records — or rather, their various pieces — but I can’t. That’s because they exist in fragments, on paper and inside computer hard drives, spread around in locked medical records facilities or in your doctors’ offices, all over the place. If you endeavored to assemble your complete medical history, from birth until the present time, I dare say you’d have a very difficult time getting together all of the pieces of paper that make it up — and it might not even be possible. That’s not to mention the cost involved in putting it together.

A few of the problems with healthcare data sharing

Do you know what my doctor’s office charges me per page? 65 cents, plus a 15 cent service fee. For a 32 year old male (that’s me) it would take a lot of pages (provided I could get a hold of all of them) and a lot of money to put my medical record together.

The sad part is that this is MY medical information we’re talking about. It’s information that health services workers obtained from MY body. It’s MY life and MY record, yet I can’t have access to it unless I fill in a special form at every doctor’s office I’ve ever visited, and pay for the privilege. Is that fair? NO. Can something be done about it? YES, and so far, Google Health is the only service I’ve seen that is trying to pull together all of the various pieces that make up my medical record, for my benefit and no one else’s. Sure, the system is in its infancy, and there’s a lot of work to be done to get it up to speed, but that’s not Google’s fault.

I’ve been inside the healthcare system, remember? I know how things work. I know how slowly they work, to put it mildly. I know how much resistance to change is inherent in the system. Just to get medical staff to use an electronic medical records system is still a huge deal. The idea of giving the patient access to the records, even if it involves no effort on the part of the medical staff (but it does, as you’ll see shortly) is yet another big leap.

Let’s also not forget to consider that medical records systems are monsters. Each is built in its own way. There are certain lax standards in place. Certain pieces of information need to be collected on specific forms. The documentation needs to meet certain coding standards as well, or the hospitals or doctors’ offices or pharmacies won’t get reimbursed. There are also certain standards for data sharing between systems, and the newer systems are designed a little better than older ones.

Yet the innards of most medical health systems are ugly, nasty places. If you took the time to look at the tables and field names and views and other such “glamorous” bits inside the databases that store the data, you’d not only find huge variations, but you’d also find that some systems still use archaic, legacy databases that need special software called middleware just so you can take a peek inside them, or form basic data links between them and newer systems. It’s a bewildering patchwork of data, and somehow it all needs to work together to achieve this goal of data sharing.

The government is sort of, kind of, pushing for data sharing. There’s NHIN and the RHIOs. There are people out there who want to see this happen and are working toward it. Unfortunately, they’re bumping up against financial and other barriers every day. Not only are they poorly funded, but most healthcare organizations either do not want or cannot assign more money to either getting good record systems or improving their existing ones to allow data sharing.

Add to this gloriously optimistic mix the lack of educated data management decisions made in various places — you know the kind of decisions that bring in crappy systems that cost lots of money, so now people have to use them just because they were bought — and you have a true mess.

Oh, let’s also not forget HIPAA, the acronym that no one can properly spell out: Health Insurance Portability and Accountability Act. The significant words here are Insurance and Accountability. That’s government-speak for “CYA, health organizations, or else!” There’s not much Portability involved with HIPAA. In most places, HIPAA compliance is reduced to signing a small sticker assigned to a medical records folder, then promptly forgetting that you did so. Your records will still be unavailable to you unless you pay to get them. Portability my foot…

Benefits trump privacy concerns

Alright, so if you haven’t fallen asleep by now, I think you’ve gotten a good overview of what’s out there, and of what’s involved when you want to put together a system like Google Health, whose aim is to pull together all the disparate bits of information that you want to pull together about yourself. Personally, I do not have privacy concerns when it comes to Google Health. There are more interesting things you could find about me by rummaging through my email archives than you could if you went through my health records. If I’m going to trust them with my email, then I have no problems trusting them with my health information, especially if they’re going to help me keep it all together.

Not sure if you’ve used Google Analytics (it’s a stats tool for websites). Not only is it incredibly detailed, but it’s also free, and it makes it incredibly easy to share that information with others — should you want to do it. You simply type in someone’s email address in there, and you grant them reader or admin privileges to your stats accounts. Instantly, they can examine your stats. Should you prefer not to do that, you can quickly export your stats data in PDF or spreadsheet format, so you can attach it to an email or print it out, and share the information that way.

I envision Google Health working the same way. Once you’ve got your information together, you can quickly grant a new doctor access to your record, so they can look at all your medical history or lab results. You’ll be able to easily print out immunization records for your children, or just email them to their school so they can enroll in classes. A system like this is priceless in my opinion, because it’ll make it easy to keep track of one’s health information. Remember, it’s YOUR information, and it should NOT stay locked away in some hospital’s records room somewhere. You should have ready access to it at any time.

Notice I said “whose aim is to pull together all the disparate bits of information you WANT to pull together” a couple of paragraphs above. That’s because you can readily delete any conditions, medications or procedures you’d rather keep completely private from Google Health. Should you import certain things into it that you don’t feel safe storing online, just delete that specific thing, and keep only the information you’d be comfortable sharing with others. It’s easy; try it and see.

Lots of work has already been done

Another concern voiced by others is that there isn’t much to do with Google Health at the moment — there isn’t much functionality, they say. I disagree with this as well. Knowing how hard it is to get health systems talking to each others, and knowing how hard it is to forge the partnerships that allow data sharing to occur, I appreciate the significant efforts that went on behind the scenes at Google Health to bring about the ability to import medical data from the current 8 systems (Beth Israel Deaconess, Cleveland Clinic, Longs, Medco, CVS MinuteClinic, Quest, RxAmerica and Walgreens).

What’s important to consider is that Google needed to have the infrastructure in place (servers, databases) ready to receive all of the data from these systems. That means Google Health is ready to grow as more partnerships are forged with more health systems.

In order to illustrate how hard it is to get other companies to share data with Google Health, and why it’s important to get their staff on board with this new development in medical records maintenance, I want to tell you about my experience linking Quest Diagnostics with Google Health.

Quest is one of the companies listed at Google Health as having the ability to export/share their data with my Google Health account. What’s needed is a PIN, a last name and a date of birth. The latter two are easy. The PIN is the hard part. While the Quest Diagnostics websites has a page dedicated to Google Health, where they describe the various benefits and how to get started, they ask people to contact their doctors in order to obtain a PIN. I tried doing that. My doctor knew nothing about it. Apparently it’s not the same PIN given to me when I had my blood drawn — by the way, that one didn’t work on Quest’s own phone system when I wanted to check my lab results that way…

Quest Diagnostics lists various phone numbers on their site, including a number for the local office where I went to get my bloodwork done, but all of the phone numbers lead to automated phone systems that have no human contact whatsoever. So Quest makes it nearly impossible to get in touch with a human employee and get the PIN. Several days later, in spite of the fact that I’ve written to them using a web form they provided, I still don’t have my PIN and can’t import my Quest Diagnostics lab results into my Google Health account.

➡ Updated 5/27/08: Make sure to read Jack’s comment below, where he explains why things have to work this way with Quest — for now at least.

That is just one example of how maddening it is to try and interact with healthcare organizations, so let me tell you, it’s a real feat that Google managed to get eight of them to sign up for data sharing with Google Health. It’s also a real computer engineering feat to write the code needed to interact with all those various systems. I’m sure Google is working on more data sharing alliances as I write this, so Google Health will soon prove itself even more useful.

More work lies ahead

I do hope that Google is in it for the long run though, because they’ll need to lead data sharing advocacy efforts for the next decade or so in order to truly get the word out to patients, healthcare organizations and providers about the benefits of data sharing and Google Health.

For now, Google Health is a great starting point, with the infrastructure already in place and ready to receive more data. I’m sure that as the system grows, Google will build more reporting and data export capabilities from Google Health to various formats like PDF, as mentioned several paragraphs above, and then the system will really begin to shine. I can’t stress enough what a good thing this is, because just like with web search, it puts our own medical information at our fingertips, and that’s an invaluable benefit for all.

Join me for a short screencast where I show you Google Health. You can download it below.

➡ Download Google Health Screencast

(6 min 28 sec, 720p HD, MOV, 39.8MB)

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Condensed knowledge for 2008-03-24

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