In some areas, small independent companies are upgrading their telephony switches to support ISDN and broad bandwidth services. I attended a recent meeting in Nebraska of a consortium of independents, and was very impressed with their willingness to make investments in new technology. Similarly, I know that the Province of New Brunswick has made a major commitment to upgrading its telephony equipment. In other states I have been shocked by the lack of knowledge or interest in upgrading service offerings to rural communities by the small independents and larger RBOCs. Though I generally advocate private sector solutions, I do see some market failures arising in rural areas as a result of deregulation that may demand the intervention of public entities.
Some states can point to successful public networks, others to dismal failures.
Like other similar networks, they are exploring the option of expanding to healthcare as well. They do not own fiber, but lease bandwidth and services from the private sector. This type of partnership is likely to arise in many states to help rural communities address the need for broad bandwidth services that do not get addressed adequately by the private sector alone. I am frequently asked, particularly by senior Information Systems Administrators, whether it is necessary to support online medical records to do telemedicine. Few existing telemedicine projects today support online medical records, though the times are changing.