Ask Me Anything! With Craig Settles, Community Telehealth Pioneer

Ask Me Anything! With Craig Settles, Community Telehealth Pioneer Banner Image

Dec 3, 2021

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About Our Distinguished Guest

Saved from a stroke by telehealth, Craig Settles pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth projects that transform healthcare delivery.

See the Broadband.Money profile of Craig Settles:

It was when Craig Settles was lying on a bed in an emergency room in Alameda, California seven years ago that the importance of fast Internet connections really hit home.    "My neurologist was able to log into the emergency room operations and she sa...

Mr. Settles conducts needs analyses with community stakeholders who want broadband networks and/or telehealth to improve economic development, healthcare, education and local government. Mr. Settles’ needs analyses opens up additional opportunities to raise money for networks, as well as increase the financial sustainability of your network. He’s been doing this work since 2006.

A community telehealth champion

Mr. Settles views telehealth as the “Killer App” that can close the digital divide because everyone experiences illness or cares for someone who is ill. Every home that telehealth touches must have good broadband. Telehealth technology and broadband in the home provide avenues for other home-based technology services that can improve quality of life, such as companion distance-learning apps, a home business app, and home entertainment apps.

He authored Fighting the Good Fight for Municipal Wireless in 2005, and since then, Mr. Settles has provided community broadband consulting services. His public-sector client list includes Ottumwa, IA, Riverside, Benicia and Glendale, CA and the State of California. Calix, Ciena and Juniper Networks are among those on his private sector client list. In addition, he has testified for the FCC and on Capital Hill.

Craig around the web

Mr. Settles hosts the radio talk show Gigabit Nation, His in-depth analysis reports are valuable resources for community broadband project teams and stakeholders. Building the Gigabit City, Mr. Settles’ blog, further showcases his expertise in this area.

Follow Mr. Settles on Twitter and LinkedIn.

Mr. Settles is frequently called upon as a municipal broadband expert for journalists at CNN, the Wall Street Journal, New York Times, Time Magazine and a host of business, technology and local media outlets. He has spoken at various conferences in the U.S, Europe, South America, Australia and Asia.

Event Transcript

Drew Clark: Good afternoon. Welcome to a special Ask Me Anything session on We are very excited to welcome Craig Settles here to talk about anything that is to say, anything that you all have asked him for this session. My name is Drew Clark, I'm editor and publisher of broadband breakfast and I'm very happy to partner with on the incredible array of tools that we've been putting together, has been putting together in helping those who are applying for grants for the infrastructure investment and jobs Act, as well as the capital projects fund provisions, and even the connected minority communities program that the applications were due two days ago.

Drew Clark: So we are super excited to talk with Craig Settles. And in this session, you should be able to see on your screen all of the questions that you and others have asked of Craig and we're gonna get to all of those. But Craig, let's just start off a second, where are you coming at us from? Tell us where you're located right now. And tell us a little bit about yourself and your background, Craig.

Craig Settles: So I am in Atlanta for the moment, I'm from Philadelphia in the beginning, but I'm normally in California. And my focus these days is a lot on telehealth.

Drew Clark: All of the questions that you and others have asked of Craig, and we're gonna get to all of those. But Craig, let's just... Sorry about that. Go ahead, Craig.

Craig Settles: That was a little crazy.

Drew Clark: Yeah, no. We have this kind of multiple streams going different places. But as long as I don't press the wrong button, it all works out, so forget that I pressed the wrong button. And back to you, Craig, tell us just a little bit about yourself, pick up where you were.

Craig Settles: Alrighty. So I am very heavily involved in the broadband Arena, Community Broadband specifically, and a lot of emphasis on telehealth as a way to drive broadband. I am not a grant writer, but I can easily provide information to help how to position your proposals so that they stand out a little bit about... Among the crowd. I think in grant programs past, there's usually three, four times as many applicants as there are awards, possibilities.

Craig Settles: And so you really have to stand out in that crowd. And so, since broadband money is about getting... For their proposals and so forth, I always figured, "Well, that's what we should talk about today." Before I started working in the Community Broadband space, I worked for about 20 years doing marketing in high-tech companies. And so I've got a lot of focus and experience in how to make yourself stand out as far as your proposals, the vision that people have for what they wanna do with this money. And in fact, I would even put in that you should look at this grant process is not just solely having a mission of getting to a one particular point, but figure out how it's going to help you over the long-haul of dealing with many things related to digital equity. So, I think that that's a big... An element of the whole proposal. What is it that you're going to try to do with the money that you're trying to get? It shouldn't be just a one thing that you deal with, but it should be part of a longer range of activities for your community when we're talking about digital equity, digital inclusion. And obviously, Telehealth is a part of that.

Drew Clark: Yeah, no. Thank you for that summary. We wanna dive into the substance of this measure, but I would love to just hear a little bit more about you personally and why you have such a passion for telehealth, Craig. We, of course, have a profile of you and what led to your passion for this, but I wonder if you could tell us a little bit about that yourself.

Craig Settles: Oh, well, yes. About seven years ago, I was just doing my thing and I had a stroke and I ended up in the ER on a Saturday night. And how I was able to survive all of that medical mayhem was because of telehealth. The neurologist at the hospital she had created a stroke center, so there's all kinds of diagnostic tools and so forth. But also she had mirrored a lot of this technology so that she could log in and be able to see the same things that the ER staff was seeing. So all the data on my condition, the scans, all of those things she was able to see, even though she was a half hour away from where I was. And though at the moment, I wasn't as aware of a lot of the things. When you have a stroke, it is not a pleasant experience. But as I was recovering, I started to think about this book that I was finishing, was Building The Gigabit City.

Craig Settles: And the trouble I always have trying to explain to people what a gigabit is, what broadband... And so the ability to talk about what broadband is, was easier when I could relate it to my process in dealing with the stroke itself in the ER. But also understanding how being connected to the internet affected my recovery, my ability to communicate, my ability to continue on with my business. And the more important part was my understanding that if I had not been in where I was, if I had been in a rural area, if I had been in an urban area that just had really poor communication, all of the things I was able to do would not have been possible. And I very well could have died in the time it took to be discovered and to have help show up and also be able to get me to the hospital in time. And that's a pretty dramatic situation, but it is also... It makes a very good way to explain to people the magic that is broadband, because people can relate to the ordeal of being sick.

Craig Settles: And so when you say, "Well, if we have good broadband, we can then have telehealth and we can have telemedicine," and all kinds of magic involving Artificial Intelligence and The Internet of Things and so forth, all of that... All of that technology now has a real meaning for people.

Drew Clark: Absolutely.

Craig Settles: And in fact, that would be, to me, one of the reasons or one of the ways that I would position your approach to these proposals. You can either say, "Well, we are trying to bring a Gigabit to the community," and everyone will have varying ways of responding to that, but usually, "What does that mean?" Is probably the big question, or the city can be focusing on wellness and mental health, being able to deal with emergencies such as heart attacks and strokes. And just being able to just go to your doctor, as simple as basic medical exercises that is, all of a sudden now, this changes when you put it in the context of Telehealth, and now the ability to be able to do that because of broadband. Now, when you're creating a proposal for whether it's NTIA or if it's for a health and human services grants, you have a better perspective of talking about what you want to have as an outcome of your use of this money you're chasing after.

Drew Clark: Well, thank you for that. And Craig, we've known each other, I've known you for probably 14, 13, 14 years. I remember, we got to know each other during the Recovery Act and the efforts to get broadband funds that were started in the beginning of the Obama Administration. And we've kept in touch and I recall when you suffered this event. And so I am really impressed with the way you've just kind of moved yourself back, just kind of fought your way back and I can't even imagine how hard that is. But to know, as you've highlighted, that it's through these capacities, through the story of this tool and how you've been able to make use of it, that really gives you a window on this subject that is just really essential.

Drew Clark: And we've got some great questions. I'm kind of gonna go in reverse chron order, and part of this ask me anything format is to just sort of ask all these questions. So for those who are watching, and I apologize if we had a little technical difficulties on the start of this, but feel free to put your questions in the chat. I guess it's the comments question, and I'm gonna go backwards. So one question we've got here from Jace Wilson is, "Craig, you've longed championed the role of community in broadband. With the upcoming IIJA," which of course is the Infrastructure Investment and Jobs Act, and the another new acronym BID which I'm not gonna try to decipher right now. With the upcoming IIJA program, it seems that community is in a big way the driver seat of decisions about which applicants win. What are your thoughts on this? What are your thoughts about the community aspect and how we make sure that community-focused broadband projects really are successful in the IIJA program?

Craig Settles: Well, I will say earlier today, I had a conversation with a city clerk at Grayson, Kentucky, and they got money through... I believe it's the... Not the CARES Act but the second one. And what was...

Drew Clark: The ARPA. Yeah. Let's just take a minute to break this part. The CARES Act of course was passed in the midst of the start of the pandemic. And the ARPA, the American Recovery Program Act, I believe it is one that was passed early in the Biden administration, but before the IIJA which was just passed last month.

Craig Settles: Yeah.

Drew Clark: And so the ARPA Act also had some additional pockets of money for broadband. So please go ahead, Craig.

Craig Settles: No worries. So what was different? And what the clerk mentioned is a big plus for this program was it didn't have many of the restrictions that some of the FCC money and the Department of Agriculture and so forth. The Treasury Department basically said to the states, "Here's money, go make things happen." And so the city talked to the state and they said, "Okay, we want $250,000 and this is what we wanna do with it, and it's gonna be for broadband and so forth." And then they basically said, they go, "Make it happen, make it work." So the state wrote a cheque to the city, and the end result was Windstream who was the primary incumbent for that area, and the city were able to move forward quickly, and they were able to move forward in a way that there was an accountability and so forth for the money.

Craig Settles: The project has benchmarks for when there's accountability for certain things supposed to be put into place, there were accountability for when certain areas were covered with broadband and the speed and so forth, and at the end of the process, the incumbent will be paid if everything else is in order. And so what was very distinct about this was the city had a lot of leeway to structure the deal and to move the deal forward. And so what the person I talked to said was, if the next rounds of money have a central flexibility and sort of a check on reality, the program will be official for the community. They won't have to wait two years to get their money back, which is really difficult for small cities.

Craig Settles: There weren't a whole lot of hoops to go through. There was an assumption that the city had identified its need, identifies who was going to need the broadband and so forth. And then when you look at some of the comments that have been going around for the last few months about the next round of money, this issue of who's going to have the ability to make the decisions and how much can this be done at the community level? I wrote this article recently where I said, there needs to be some group from within the community that has an impact that says if we don't get what we're supposed to get from this money, that vendor doesn't get paid. And I think this... What we need to have happen with the next round of money is that that kind of accountability.

Craig Settles: And I also... I can't remember what interview I was in, but the question came up about what can the average person do to make the changes that are necessary? How do you... You're here in the Kipsey or Montana, and you're not in the realms of how Congress, so what do you do? I think it's going to be important that the city leaders and their state representatives impact the process of the rules. There's a bill pass, and that's pretty exciting, and yes, it says, well, we're getting all this money, but the actual rules for how this money is dispersed, the roles of the state, the roles of the city, the roles of the federal government, that's in a rule-making process that right now, the incumbents are working feverishly to make sure that the rules that show up are favorable to them. And the only way that communities can counter that, is there has to be some work among the state, the communities. And you have several organizations. There was the public knowledge, there's Chris Mitchell's organization. NDIA.

Drew Clark: The National Digital Inclusion Alliance there.

Craig Settles: Yes. And these organizations have done a very good job of building rapport and clout so that they can counter the incumbent, when the incumbents try to do rules that... And so ultimately, the communities have to bond with the state and these various groups to put their mark on these rules and regulations.

Drew Clark: Well, great point. Let's keep going through the questions, we got 20 of them now here. And I really wanna get through as many as we can, but I think the key points you made there, Craig, is that we need to counter to the incumbency. And I think what you've also said is that there's a lot of things that have been put in place that may be able to do that, but we have to be mindful to make sure that local and community is really keyed up. So, we got a question here from Justin Perkins who's a reporter at broadband breakfast. "Craig, you've emphasized the role of Telehealth in developing broadband grant applicants and applications, all communities have different demographics and needs. I'm thinking about how surprising places like barber shops," you've written about that, you've written about that for us Craig, and we really appreciate all of the things you've done for us at broadband breakfast over the years, but back to Justin's questions, "I'm thinking about how surprising places like barber shops can be a point of contact for telehealth services." Could you share how applicants can highlight varying community needs in their application processes?

Craig Settles: Okay. First off, I think there needs to be a needs analysis program put into place in which the stakeholders, meaning people from the healthcare side, the broadband side, specific leaders, non-profits, they need to be part of a needs analysis process where you are identifying what are the needs for the community, but also you have to develop an inventory of what are the places and facilities and so forth that you can use to deliver telehealth services.

Craig Settles: So if you look at churches, non-profit organizations, programs that help seniors, the barber shops, you look at where people come together. In Salt Lake city, they discovered that there are certain markets that attract people from South America, and a lot of the people that come in there are very comfortable with that environment and the people that are there. So what Salt Lake City and County did was they created a digital Navigator Program. And what it does is the navigators, they find communities there, how the people communicate within those communities, and then how can I or how can you get those people to become part of the solution.

Craig Settles: Again, and then the value of that, besides the obvious value from a grant perspective with the federal government in particular, your ability to bring examples of who supports this program that you're asking for money for. Because what they figured out in the broadband stimulus back in Obama's presidency was getting that grassroot support is a very good indicator of, Will that project work? If all of these hands are on deck making this thing work or putting in their needs, and then all this analysis and so forth. You have a more likely possibility that you will get those people engaged after they've been granted, after they've been getting that money.

Craig Settles: And so this is the way, because we that are within the industry, the activists at a national level and so forth, we don't know what the needs and the conduits for action are within the community, but you have to have that process of doing the needs assessment and then that gets, ultimately, to your question about where or what are these different avenues that we can use for telehealth delivery.

Drew Clark: Okay, great. Great answer to that question. Let's move to the next one, this is from Benjamin Con, who is also a reporter at broadband breakfast, "Hi Craig, my question to you is about municipal broadband. A lot of people across the country are dissatisfied with their ISPs, but live in areas that are only covered by one or two providers, and their state may actually outlaw municipal broadband. What can the average person or business do to improve their situation, particularly if they live in a state that doesn't allow mini-broadband infrastructure?"

Craig Settles: I think the answer is to find alternative delivery mechanisms for the broadband build out. The obvious one that are co-ops and non-profits, but then there's wireless ISPs. And we normally think of the wireless folks as being rural, but in reality, maybe about 10% of the list are urban and there's room for many others. So if you have a regulation that prohibits municipal networks, then it is time to look at community foundations. There was a project I worked on in Iowa where we were gonna work with the city's Foundation, because it would be easier and it would take away the political aspects.

Craig Settles: Same with non-profit organizations, there are non-profit ISPs, there are various non-profits that have the conduits and the connectivity with the community, where you can hire a broadband builder, you can outsource the engineering part, the management of the network, various aspects. And so rather than to think about it as, well, there's only one way to do this. Now, is the time to look at alternatives. And the non-profits are a way to go because you have to obviously have to be in the wrong... The right size and all of that, but they are fiercely loyal to the community. They're gonna want to do things that are in the community's best interests, and so give that a shot as the way to move forward.

Drew Clark: Absolutely. And I think what you've highlighted there is the role of Co-ops, Electric Co-ops, Telephone Co-ops. They've played a huge role in the last several years, and they obviously got involved in the rural digital Opportunity Fund the last year. And I think Rural co-ops are really poised to play a very, very large role in the IIJA and implementation. I wanna get to a question I actually posed here in the stream, one of the key stumbling blocks to the greater deployment of telehealth seems to be reimbursement issues and also regulations governing the ability to practice healthcare across state lines. What is your opinion about how these issues have been affected by the COVID-19 pandemic and what is likely to happen with regard to these restrictions, cross-state telehealth, telemedicine in the future?

Craig Settles: What people need to understand on where we were before the pandemic, there were insurance companies and other interests that wanted to have either no telehealth or very controlled telehealth. And they wanted to, in essence, say that if you're gonna get our money, insurance money for this patient, you have to take less. When the pandemic hit, all of a sudden there, a lot of these rules dropped. The whole thing of not being able to cross state lines or you're a patient in one state and you're a provider, or your doctor is in another state, a lot of those rules were declared null and void for the moment.

Craig Settles: So what you have is a number of folks in the industry and in the healthcare and the insurance industries, they wanna go back to where we were before. And that is very much the danger because all of these things were enacted with the understanding that it was a temporary focus. So what has to happen is, again, the cities, the counties and so forth, they have got to make a noise. Because basically, you got interests that are not the public's interest trying to make rules that are favorable for them. And I think that you have enough people that have tasted the water of telehealth, they are not going to wanna go back.

Craig Settles: So hone in on that, organize that, make a loud noise in the places where they need to make that noise to make sure that we're not going back. I think one thing that was pointed out to me in a meeting I had was, also understand where the insurance companies and so forth are coming from, and where their financial interests are. Because one of the things they do have issue about is, if you don't have broadband, then can I go and can I call my doctor? And it's not obviously full telehealth, but at least it allows you to reach out to your doctor and have a consult.

Craig Settles: The insurance company is kinda like, we might be okay with telehealth, we got problems with the vocal, that thing, the telephone, that may have to be a [0:32:57.9] ____ position, then that means you're gonna have to work harder to get the broadband part installed. And I bring that up so that people understand what the dynamics are that we're trying to address. I think that what we have seen is a number of folks see a benefit. I'm referring to the insurance company folks, and then the healthcare industry see value in having telehealth. And so even though they were resistant in the beginning, they're starting to move away from that entrenched position. And again, the communities have got to rise up and say, "We understand where you're coming from, but we're not going back."

Drew Clark: And I think the pandemic has really forced the hand of those who wanted these restrictions on telehealth. Let's keep moving, we've got a number of great questions we wanna get to, another one from Jace Wilson of is, "Craig, you once said, upload speed is the Achilles heel of telehealth. Could you say more about that?" Upload speed is the Achilles heel of telehealth.

Craig Settles: I actually wrote an article recently that said that broadband is the Achilles heel, but either or the problem is, our broadband world has been predicated on lots of downloading of information, very little pushing it up. And then for a while, that has been the norm of broadband.

Craig Settles: If you had a network that was predominantly seeing entertainment traffic, that's all going down downstream. The problem is, when you talk about distance learning on the one hand, and you have telehealth on the other, both of those applications are demanding that a lot of this data goes upstream. And so your network, the mentality for the design of the network is in that mindset of lots of data down, not so much up. If you're gonna have true telehealth, the same way you're gonna have true distance learning, you have to have both. Yeah, you almost need symmetrical speed. And that's going to run into the mindset of, "Well, we don't need that."

Craig Settles: But in reality, when you look at the ability to have my X-rays and scans, I can't my words out. All these very data-intense files that I'm trying to get from me to the doctor or the doctor back to me, and we wanna have a consult in real time, or I got a guy who's very much into the mental health aspect of telehealth. And he said the assumption that the telehealth is only going to be the video traffic, which we're getting to where we can try to get that doable. But for the process of doing psychiatric consults and so forth, doctors need to have access and the ability to get large files from various sources uploaded. So this issue of the 25 and three is counter productive. In his perspective, he's saying anywhere from 30 to 100 Megs is what you're going to need. And so when you look at getting ready for surgery, getting recovered from surgery, where they wanna see your wounds to tell if you're recovering properly, those kinds of application of the technology is going to need more and more bandwidth.

Craig Settles: We're talking about using artificial intelligence for consulting, for mental health issues, trying to deal with the people who are stuck at home, seniors. Where you're trying to figure out, have they fallen or are they just sitting down? Have they gone to the refrigerator to fix a meal or not? All that stuff takes bandwidth to have the sensors be able to do all of these things that they can do. And so again, yes, if you're dealing with small and low upload speeds, you're very much treading on the heels of your potential.

Drew Clark: So this is not telehealth per se, but I remember talking with some people doing medical work in... I can't remember if it is Provo or another city in Utah. And they did have a gigabit fiber network available to them. And because they did this they could send cat scans and things, but really from home. They had this kind of connectivity at home, but when they went to their office, they couldn't do this kind of telehealth. So that was more sort of medical diagnoses, not telehealth per se, but I guess it is, it really is part and parcel.

Craig Settles: Yes, technically that is part of the telehealth process. We're basically... Telehealth is using the internet and intranet to move all kinds of data, to do all kinds of issues related to the wellbeing of the individual, their mental or their physical. And so when you look at the extent of what you're talking about, the issue of is it telehealth or not. If it's regarding the person's health, then yes. Even if it's a research, it's just I might call it passive telehealth. I go to the library and I get a bunch of video tapes and interactive software that helps me go through rehab and so forth, that's still telehealth. And then the reason why you're having it discussed in that way is when you're creating telehealth applications and services, you also can look at well, who can be part of that. And a question was asked earlier about can we use the barber shop? Well, you could probably use the library. Because no one knows data and research and all that kind of stuff like librarians do. And so that is part of the solution usually.

Drew Clark: Well, great. Let's keep going with some great questions here. This is from TJ York a reporter at broadband breakfast. What project you've worked on in your career, do you think has made the greatest difference for people? Interesting question. Thank you.

Craig Settles: Yeah, I would say that, my value is my writing and presenting knowledge and so forth. When the company or city says we used your book or your reports and so forth to execute our needs and analysis and so forth. That's where I get the most bang. I sort of look at there are services that I can do, but I may do them just a couple times a year and they may not be spectacular, but the information that I have produced from the very beginning when I wrote about the Philadelphia wireless program and so forth, where lots of people were reading that information and understanding what's good and what's bad what have you. And so that's where I feel my role has done the most good for the most number of people.

Drew Clark: Okay. Well, let's keep going through some great questions we've got. This is from Benjamin Con at broadband breakfast. Are you supportive of the technology neutral approach laid out by the Infrastructure, Investment and Jobs Act? Do you think that technologies like cable, DSL and satellite are scalable enough to meet the telehealth demands Americans have in the 21st century? What are your thoughts on that, Craig?

Craig Settles: If satellite and... Yea, if you're talking about satellite, I don't really feel like that's broadband. There are problems with it and I just can't even begin. I know that there are at least in press releases, there is all this advancement and stuff that's coming up with the satellite technology. But, no, I don't believe that's really an issue. I think that the types of technology that makes a difference, our basic stuff, the fiber, the wireless, fixed wireless and so forth, they have a place. We have artificial intelligence, the internet of things, we have all this smart city technology, I consider those, these last three I just mentioned, as a major part of both the broadband and the telehealth in a world as we go forward. I've had people explain, for example, when you a have a stroke, or you have any kind of injury, where maybe you gotten into a car accident or what have you.

Craig Settles: One of the things that is incredibly boring is rehab. But at the same time, it's necessary. So I remember, was it, US Ignite, one of their executives said they were looking at technology that would allow a patient or a doctor to be able to determine if a person's knee is rotating 10 degrees versus 20 degrees. Things that you wouldn't even think about, especially when you're talking about, I'm sitting in my house and my doctor is wherever, and you're using this connection to be able to say that you're moving a little bit wrong for this drill. It's not commercially available, but there's a company working on that, which means there's probably other companies. So the potential for Artificial Intelligence to make healthcare just go to the next level, that is just incredible. It will take some time and all of that, but the foundation will still be, "I need to have that internet connection, and I will still need to have a doctor or a therapist or what have you." That's gotta be part of the equation.

Craig Settles: But I think that the potential for things coming down the road is enormous, and so when you're building or proposing to build a network and is gonna cost you $20, $50 million, especially for a larger city, that will cause some people to be in consternation. However, when you look at what's coming down the road in Telehealth, I think that it's a valuable investment because there's this thing of trying to get just enough bandwidth so we can do this stuff kind of today. And the problem is you have shot yourself in the foot for your future.

Drew Clark: Good. Thank you. And let's keep moving through some questions here. Are there any Telehealth technologies or innovations that you've seen recently that you think have not received enough attention, Craig?

Craig Settles: Yes, I've actually witnessed a demonstration where... What is it? They're scanning your retina to determine a number of things, because if you don't realize that when you get this eye exam, there are a number of other health conditions that can be flagged by the retina scan. A possible stroke, a possible heart attack, diabetes. And so that's a... I haven't read about it in a lot of other places and so forth. I would say, to me, that's one of those things. It's basically, the eye exam. And you're saying, well actually, if I do this correctly and I get the right data streaming to me from the patient, I could actually foreshadow this person possibly having diabetes just by the retinal exam. That's pretty, in my mind, fairly crazy, in a good way. So I stick with that.

Drew Clark: Okay, cool. One question I've got here is, do you have any opinions about This question is from Ron Suarez of Have you heard of, Craig? It's kind of a decentralized wireless technology using blockchain, and I just was just wondering if you had an interaction with that at all.

Craig Settles: Yeah, I have. Actually, I talked to Deborah, the president, a few times. And there's blockchain, which I have almost zero knowledge of, so I won't even pretend that I know anything about that, but their decentralized approach to getting broadband built is valuable. They basically say, "Let's get a group of community people to invest in this infrastructure, and then I will also have people who can't afford it to be part of the service nevertheless, because they need to be a part of that service." So I think that concept is stellar. It has been talked about off and on for a number of years.

Craig Settles: I think that Althea has been really diligent as they have brought this on... Bringing this out, but I think this concept of "My Brother's Keeper" or "My Sister's Keeper" in the process of deploying broadband, it's the right thing to do. It may not make [0:51:32.8] ____ happy, but I think that Althea and the other companies that want to push that forward, there is definitely a place for that. Because ultimately, whether we're talking about digital equity, health equity, we have a part of the population that for whatever the reason, and often not of their own engineering, they are at a disadvantage. They don't have stuff that they need, and it's like there's all these forces working against them. So having someone that's saying, "This broadband stuff is so important, that yes, we need to find ways in which we can be our brothers and sisters keeper with this technology."

Drew Clark: Ron Suarez raised another question, "When I was in California, I was not allowed to have a video visit that had been scheduled with my doctor in Michigan." And I can say this is an issue I've dealt with too, interstate medicine, how and where should we raise this as an issue with Medicare insurance?

Craig Settles: When you say where, do you mean who should I call or who should I complain to?

Drew Clark: I guess so, it's just Ron's question. Yeah.

Craig Settles: Ultimately, there are... Again, I come back to what I said earlier, there are forces, the large incumbents, the large insurance companies, the large hospital chains, they have their own bottom line interest, and they are often going to be at odds with the general community, definitely at odds against low-income folks. And so the only way I see... You've got to create a force within the community that will then go to the politicians, and as much as it's a pain to do, it's the only other process. We talk about, let the market decide and let market forces decide and so forth. And at some point, some point, someone has to say the interest of a particular market or a particular player [0:54:29.2] ____ benefit of a large swath of the public. But the only way that you're gonna overcome that, 'cause you gotta organize and you have to make it that politicians have to pay a price if they don't respond.

Craig Settles: I've brought this thing a lot of times, [0:55:04.5] ____ but at the State level, when you have these politicians that are making laws that are not to the the advantage of people and their health, people and their broadband connections to the world and so forth, you've got to exact the price out of the politician in order to make a change. Either you've got to run against them, but you've got to somehow, you've got to make it painful. I can't explain.

Drew Clark: Do you think that the rule-making process for IIJA rules can help on something like this, Craig, or is that more...

Craig Settles: It should be. Because what we're having is a situation where we have a healthcare industry over here and we have a broadband industry over here. And there are times, when in the middle, there are policy statements that will affect one directly and the other one indirectly, or vice versa. And so there has to be some movement of moving those industries together because you can't have broadband without... I'm sorry, you can't have telehealth without broadband. And I would say that a lot of your broadband is... You're gonna have to have strong reasons for why people want to actually pay for the broadband.

Craig Settles: And so the good or the fate of one industry is affected by what's happening with this other industry, and I think that that... And so this money that's being set up, again, everybody on the telehealth side should be on board and making, writing letters. There's a public comment period for the rule-making process. Everybody in telehealth needs to be on that one. As the same way that if there are rules and so forth for the grants for health and human services, or one of the various agencies that fall underneath that. When I talk to a number of the folks at the Health and Human Services, my question was, "Well, one, do you understand or do you believe in Telehealth?" Because when the pandemic started, there wasn't a...

Craig Settles: I got a sense that there wasn't this enthusiasm for telehealth. The basics of telehealth are medicine, yes, but telehealth was kinda out there, but there are people starting to change from that. But then that means that the role of broadband in Telehealth, there can very well not be people in the health and human services group that fully understands why when you give someone a million dollars for a telehealth solution, if you have not somehow addressed the broadband who has it and who doesn't have it, you're destined to have a stunted success rate. There were three, no, two rounds of money from the FCC that went to health care providers for telehealth solutions, which was great.

Drew Clark: Just to clarify, what programs you're talking about on these two rounds of money for telehealth solutions?

Craig Settles: So the FCC had a specific telehealth fund that I think it was 'cause of a pilot fund, that was the terminology that was driving it and so forth. And so when they were giving away this money, for one example, I have one example, there's a medical practice in Cleveland that primarily served low income folks, they had seven offices. So when they got this money, they restructured their entire operation to be telehealth in someone's could be first time, but when anybody any patient came in and says, Well, I don't have a good connection. I have no connection. No one knew what to do about that. It was sort of like you gave this money, but you didn't understand your people that have actually used it, 'cause it wasn't just the healthcare organizations, they're the people on the street. And you gotta have both sparse groups solved. Well, this is, to me, an issue that probably exists within the healthcare agencies that someone had better be championing the broadband side, or else you're gonna have this issue of you've enabled your healthcare professionals, but you haven't addressed the individual patients and their broadband situation.

Drew Clark: Yeah. Well, we have used the hour, I'm gonna do some wrap up... Exactly. Do some wrap up questions here that hopefully you can kind of combine, and there are many we didn't get to directly, although we've talked about bits and pieces of them. One is about a significant issue preventing telehealth program adoption is that many consumers are simply unaware of the programs that are available to them, how do you suggest communities combat this lack of awareness, and maybe we can use that as a closing thought for other things that you think our listeners need to know about telehealth and including telehealth as part of broadband grant application programs under the IIJA and other program, s Craig.

Craig Settles: Okay, so when I did this project for Tom in Iowa, part of the needs assessment process was to break... One day, there were service groups companies, there were nonprofits. Another day, there were third like now. So part of the course was, having conversations with stakeholders, what is the value of broadband and what do you wanna do with it? What do you wanna do with it if you build this network? And then you go to the groups, in Philadelphia they were called, they were focused groups, they had 10 of those representing different parts of the city. And so the first five minutes, 10 minutes is education, educating people on what is telehealth? Because we don't really fully understand. And then once you have that knowledge out there, then you start asking people, What do you wanna do with it? And I think that, that is pretty much...

Craig Settles: If you attack the telehealth issue, the same way even for any other aspect of broadband applications, is that you have to educate people for what exactly this is, what you're talking about, 'cause as we talk about, we throw out technology issues. Again, what's data, what's a mega bit, there are still people that have no idea what that means. So if you want to take advantage of this money and have [1:04:20.2] ____ official in the long-run, somewhere on the front-end, you gotta educate people on this study. So that people gotta know what the wanna do with it. People have to know what they wanna do with this technology if you wanna have a successful fundraising effort that actually goes somewhere. I talked to someone who their city made broadband available for free to 5000 homes. One of the objectives was education, the second was telehealth only 1000 people took them up on that offer. When you dig into the what was the issue, the advertising for this program wasn't right, it wasn't targeted. No one to talked to ministers. No one talked to other unofficial leaders within the community. Unless you have all of those parts educated to what telehealth is, if you're only after money, this isn't gonna necessarily help you in the long run. That would be my say on that.

Drew Clark: Well, thank you so much, Craig, for taking this time for this ask me anything on Craig Settles, expert broadband consultant and telehealth expert indeed. He attributes telehealth to saving his life. So what an incredible story. Craig, we'll put the link to it back up on this page, and you can watch it any time here and watch this stream any time. For Craig, I'm Drew Clarke at broadband breakfast and we will see at our next Ask Me Anything two weeks from today again, at 2:30 PM Eastern time