Rural telemedicine: satellites and fiber optics.

Rural America Telemedicine requires very high bandwidth to provide timely transmission of large data sets. These resources may take decades to appear because of the economics of low population densities and costly installation, and the historically low rate of bandwidth improvement available from the common communication providers. Satellites provide the natural choice for communication between the rural primary care centers and the tertiary care hospital. Furthermore recent improvements in technologies have substantially reduced the costs of ground stations. A network of satellite ground stations with symmetric bandwidth connected by satellite is the architecture of choice. Analysis of multi-station satellite access clearly argues for distributed non-random methods and hence for appropriate handling of TCP data streams. However the overhead in delay of Satellite based TCP, as required for Internet access, substantially increases the transmission time and hence cost. Simulations of TCP/IP data over satellite links show a substantial reduction in transmission times. Initial business models show that the transmission cost per second is 60 times that of telephone lines while the increase in speed is nearly 3000 fold, effecting a 50 fold cost savings. But over decades, the infrastructure can be expected to improve. In particular speculative fiber optic installations in power lines and along major highways are betting on future traffic. These so-called dark fibers take advantage of synergistic installations. Their small size, ease of manipulation and gigantic bandwidths (in terabytes) allows for economic installation in anticipation of future use. Thus for rural America a strategy can evolve in which satellites provide an intermediate solution to high speed data communication while the terrestrial fiber-optic infrastructure catches up.