IT’S TUESDAY, so it must be Italy, and New Zealand fashion designer Benny Castles, one of the three founder-directors of the iconic WORLDfashion label, is on a buying trip in Milan. After a busy day of meetings, he heads back to his hotel room to check emails, phone messages… and the new season displays at his seven New Zealand stores. He logs in to security video footage of the store, and pans around men’s fashion, women’s, beauty products, watching customers interact and respond to the new season lines – where they go, what they take off the racks. He checks against sales data, and sends a message to staff at one store with ideas about moving a certain display, highlighting a different outfit in the window. On the way out to an evening show next day he jumps on his mobile phone and notices more people have been stopping to look at the new range. With business taken care of for the evening, it’s time to enjoy the sights of Milan.

At Auckland Catholic boys’ school St Peter’s College, science teacher Dr Michael Harvey is taking a year 10 chemistry class. Last night, for homework, the students watched a video he had posted online, giving them background and instructions for today’s experiment. Then they completed a short online quiz to make sure they understood the material. Harvey says getting the theory out of the way at home leaves more time for the fun stuff – practical experiments in class.

Later in the term he’ll have the boys work on a project about the boiling point of water – and how it changes with different conditions (altitude, for example, or if you add salt). Instead of getting them to write their findings up, students will present their conclusions as a 3-4 minute video – with popcorn.

Harvey says videos solve a major problem for teachers in the post-Google era – students randomly cutting and pasting information (that they may or may not understand) from the internet. And video is also a far more engaging way to learn, he says. “Students tend to see science as rote-learning facts. With video it becomes exciting and creative.”

A hundred kilometres away from Auckland, a young man is rushed into the A&E department in Thames around midnight, another car crash victim from the Coromandel’s narrow, winding roads. The sole-charge emergency doctor at the rural hospital works on the patient, but cameras in the resuscitation room allow him to consult colleagues in Waikato Hospital if he needs to; the high definition live images relayed to Hamilton via fibre broadband mean the specialists in the main hospital can see the man’s skin colour, slight movements of his chest, and details of his wound, to help make decisions about the man’s care.

WHERE IT ALL BEGAN

The telecommunications industry started rolling out Ultra-Fast Broadband (UFB) in late 2010, in an ambitious $5 billion programme designed to bring fibre optic cable to 75% of New Zealanders by the end of 2019.

Four companies – Chorus, Northpower, Enable and Ultrafast Fibre – won contracts from funding agency Crown Fibre Holdings to deploy UFB in different parts of the country, but take-up was initially painfully slow. By April 2012, just over 1000 premises had hooked up, less than 2% of those with fibre running past the door. A year later, the figure was about 3%. The problem was that although UFB made some stuff easier – moving big files around, for example, or accessing cloud services – the perceived lack of a killer app meant many people didn’t understand the benefits of really fast fibre, as opposed to the broadband service they aleady had.

Jessica Jones never looked so good.

CONTENT REALLY IS KING

What a difference four years make. A proliferation in content has, as many predicted, been the making of Ultra-Fast Broadband. Tech community Geekzone.co.nz lists 66 video, movie and TV download and streaming services available in New Zealand – and that’s just the legal ones. The list includes local and international TV stations, local movie and TV show providers (Neon, Lightbox, WatchMe and Igloo, for example) international movie streaming services (Netflix, Quickflix, Popcornflix, etc), and unexpected items like Crunchyroll (anime/manga simulcasts) and Twitch (the video game streaming website bought by Amazon for $US970m). And the list doesn’t even include live video-streaming mobile apps like Meerkat, Periscope, YouNow and Facebook Live.

Suddenly, any self-respecting household has up to 14 connected devices and we’re all watching our favourite content via the internet at the same time. “Screenagers” are connecting to different video content on each of their devices (and possibly a few of yours too) at the same time. Internet service providers estimate video makes up 50%-70% of household traffic.

Having several people in a household watching their own content can play havoc with quality. Even if you are home alone, there’s no doubt streamed programmes look smoother and sharper with UFB. As tech writer Chris Keall wrote with relief after getting UFB connected at his new family home: “Jessica Jones never looked so good.”

While in 2012, retail service providers found it tough to get people to connect to fibre, now the challenge is how to meet booming demand. UFB statistics show connections grew 135% in 2015, and uptake (the number of people choosing to connect when fibre goes past their door) was up from one-in-nine in 2014, to one-in-five. In some cities it’s higher. In Whangarei, Blenheim and Tauranga, for example, take-up is more than 25%. In early 2015, around 5000 households and businesses were being connected each month, Communications Minister Amy Adams says. Now it’s 11,000.

“Screenagers” are trying to connect to different video content on each of their devices (and possibly a few of yours too) at the same time. Internet service providers estimate video makes up 50%-70% of household traffic.

Enable CEO Steve Fuller said at a conference in February that his company had expected demand to peak in 2018/19, but the industry was “hitting that peak three years early” – and that’s causing some problems for providers. Potential customers at Enable have to wait an average 40 days to get hooked up to UFB. Meanwhile, at Chorus, the median connection time for a single dwelling is 17 days. Part of the problem is simple logistics – Chorus CEO Mark Ratcliffe said at the Telecommunications Forum (TCF) conference in February that fibre providers need to double the number of UFB rollout technicians by the middle of the year to meet demand – but recruitment and training take time.

Solving the bottlenecks around multi-tenanted buildings and rights-of-way is harder and will involve changing the rules around getting consent from neighbours and building owners.  Minister Adams is onto it, she says, though the solution may be months away.

Meanwhile, it’s not just fast broadband connections that are booming, says Chorus network strategy manager Kurt Rodgers. Another consequence of the Netflix effect is we are all using far more data.

“The long term historical growth trend was for a 50% increase per annum in the amount of data used by each broadband customer; we’ve got data for 2011-2014, and each year is tracking in line with that 50% per year number. So in terms of our capacity, we planned for a 50% increase in traffic.

“But the last 12 months has been different. Growth was closer to 100%, and that’s more than most people in our sector expected. We’ve had to put a lot more effort into augmenting capacity and doing it quicker.”

EXPONENTIAL GROWTH IN DATA

Is this just a bubble? Rodgers doesn’t think so. More people watching more video (because they have nice fast broadband to watch it on) is only one factor that will keep data consumption growing in the future, he says. Step improvements in quality are also chewing through bandwidth. Tech advances like 360-degree cameras, augmented and virtual reality, 4K TV (also called ultra-high-definition TV), and high dynamic range video (where colours are richer and more varied), all require big increases in bandwidth. So as all these developments become more mainstream, bandwidth requirements are going to continue to spiral again, he says.

“Early adopters don’t impact on our network, Rodgers says. “But we notice it when a technology moves mainstream. That’s what happened last year; services like Lightbox and Netflix, took online TV mainstream.”

Rodgers is predicting we’ll be using 100% more data each year for the next few years at least.

“The cost of each additional 10Gbps of capacity is a lot less than it was five years ago, but still the price isn’t going down as fast as the traffic demand per customer is going up. We have to work out how to bring the two curves – cost of increasing capacity, and revenues from the growth in demand – together.”

To put this into perspective, recent Chorus figures show the average New Zealand home used about 96GB of broadband data in January across the copper and fibre networks – and fibre households used nearly 200GB that month. That means the average household is using the same amount of data in a year as the whole country used in a month in the late 1990s.

Chorus says 46% of its new UFB fibre connections are for 100Mbps speeds or higher.

(Another interesting statistic shows that the peak time for data consumption is 9pm, which kinda makes sense – dinner’s over, kitchen’s tidy, little kids are in bed, phew, get those devices out. What is more intriguing is that almost every week, the peak 9pm loading day is Thursday. Why Thursday?)

OK, so the Netflix effect is powerful – Netflix came to New Zealand in March 2015, so the dates tie up with the explosion in fast connections and data usage. But concentrating on the impact of video only in our home lives is hiding the bigger picture, which is that video, enabled by fast fibre, is transforming our lives in a broader and more meaningful way – more meaningful even than Jessica Jones. Video is becoming a vital tool in medicine, business, teaching, even government.

A RINGSIDE CONNECTION

Look carefully and you find video in the least expected places. Like the Karaka yearling sales, which are broadcast live around the world via UFB link. As each horse comes into the sale arena, ringside cameras show the horse to potential bidders as far afield as Asia, the Middle East and Europe. Buyers watch the action on a smartphone, laptop or tablet, gauge the tenor of the sale, and instruct bidders in New Zealand; the bids then show up on their screen in different currencies.

Last year, one of the auctions saw 5000 people on site at Karaka, plus 180,000 viewers watching remotely, over six days of sales, according to Richard Naylor of tech company R2, which handles the live streaming. The process involved 12 terabytes of data and over $90 million-worth of horses changed hands.

A REVOLUTION IN MEDICINE

It’s exciting stuff. But perhaps one area where video is impacting more than any other is in the medical field. Telemedicine, defined as the use of technology – including visual technology – to remotely diagnose and treat patients, has the potential to revolutionise healthcare, especially for people in rural areas.

Actually, telemedicine isn’t new. The first international forays happened half a century ago, but New Zealand has been slow to take advantage of the possibilities, says Dr Ruth Large, clinical director at Thames hospital and, since August 2015, also clinical director for virtual healthcare at Waikato District Health Board (the first person in the country with that job description). Large reckons after five years of telehealth proofs of concept in the Waikato DHB and over 20 years of experience, New Zealand has reached a tipping point where the technology could really take off and start benefitting significant numbers of patients.

Large’s own health region, which stretches from the top of the Coromandel peninsula to National Park, covers a population of 373,000 people, of which 60% live rurally. The most remotely-located patients have to travel for three-and-a-half hours each way to get to the main hospital in Hamilton, which is why Large and her team’s main focus is on how to deliver as much healthcare as possible at a local level – either at the four rural hospitals (Tokoroa, Te Kuiti, Thames and Taumaranui), at GP surgeries and medical clinics – or even at home.

Projects range from rural hospital emergency rooms being equipped with high-resolution video units so specialists in Hamilton can help A&E colleagues with complex cases, to virtual outpatient clinics so rural patients don’t have to travel to Hamilton for appointments, or clinicians visit rural hospitals. There are teledermatology consultancies, where primary healthcare providers get help via video link from consultants in diagnosing and managing skin conditions, and virtual ward rounds, where Hamilton-based specialists can talk to patients in a rural hospital via “telecart” (a trolley with a screen and camera).

Large says the DHB launched a new mobile application in March. “This is a two-year trial, looking at the applications for this sort of mobile telehealth and how we deliver it. We want to work with as many groups as possible, to use the technology as much as possible and see what comes of it.”

Waikato DHB chief executive Dr Nigel Murray told the Waikato Times last year that access to healthcare in the future is going to be defined by patients, not providers. “They will want access through their personal devices, their smartphones, or desktops. I am going to say something quite bold here; I think we have way too many outpatient appointments in our central facility in the Waikato. Do we really need patients to travel to the hospital every time? Sometimes yes, many times no. Many of those appointments can be delivered in a virtual sense.”

Meanwhile, another project sees cancer specialists at Auckland, Waitemata, Northland and Counties Manukau hospitals holding multi-disciplinary meetings (where all specialists involved in cancer care discuss the treatment of new and existing patients) by high-speed telelink from their own sites, saving hours of travelling time in Auckland traffic. The system, provided by Vivid Solutions, the largest provider of health video conferencing services in the country, involves fast broadband networks and big screens in each hospital, allowing doctors to see each other and share scans, x-rays and patient notes.

EMERGENCY TRIAGE – BY VIDEO

Another project, still in development, aims to use technology to reduce waiting times for some patients at accident and emergency clinics – and get urgent cases dispatched to hospital quickly. The idea involves Auckland network and app service provider The Instillery, cloud VC company Blue Jeans and two new A&E clinics in Auckland and Hamilton. Instead of patients arriving at the clinics having to wait hours for a doctor, who may well just send them straight into hospital anyway, the plan is for patients to be triaged quickly by video conference and sent to hospital immediately if necessary.

While home-based care via video conference is rare at the moment, it isn’t unknown, says Simon Hayden, chief executive of Vivid Solutions. For example, the company installed a direct video conferencing link between Starship Children’s Hospital in Auckland, and the home of a terminally ill child in Mangawhai (Northland), Hayden says, allowing the boy to spend his final days at home with his family.

“Before that, the patient was stuck in hospital, with most of his family in Mangawhai, where his parents also had a farm to run. One of the clinicians asked if we could put a video conferencing connection into her home, using their home broadband. We set it up, the quality was fantastic and the child got to stay at home with his parents and siblings, with specialist expertise, GP and nursing support from Starship by video link.”

In that case, the link was via satellite, Hayden says, but these days, UFB and iPads would make the process far cheaper and easier to provide.

Another Vivid Solutions project involves remote monitoring of tuberculosis (TB) patients by video link. World Health Organisation guidelines say that the best way to make sure people with TB take their full course of antibiotics, is for a nurse to watch them take their drugs each day.

“This directly observed therapy (DOT) is intrusive, with patients feeling they can’t be trusted to take their own medication,” Hayden says.  “It also meant that communicable disease nurses used to spend up to five hours a day travelling between patients, or stuck in Auckland traffic – just to spend 10 minutes with each patient to ensure they took a few tablets.

“The introduction of our TeleDOT service means many TB patients now take their medication using a secure video link from their iPad, laptop or even smartphone.”

Public health nurse Carolyn Pye says TeleDOT makes a difficult medication management pathway easier.

“I have one client who is a university student so I used to meet her outside the university. She would sit in my car and take her medicine. She was the first person to use one of our new iPads with the TeleDOT software loaded. On day one, when she took her medication in the student café using TeleDOT, it was the first time I saw her smile.”

The potential telemedicine applications are huge. Take the rural mum with three small children, one with a rash. What if she could have a remote consultation with her GP, using her webcam or smartphone to talk to the doctor and show her the child and the rash – rather than bundling three kids into the car and driving for an hour? What about GPs or specialists working with rest homes and hospices to do remote consultations with patients who can’t leave their beds? Or why not manage some of the day-to-day care for a patient with a heart condition at home, using an app where the patient records their blood pressure, exercise regime and medications, and has daily Skype contact with a nurse. What about more people with terminal illnesses in rural areas being able to stay at home, with palliative care nurses and specialists doing most of their “visits” by video link?

In theory, Large says, up to 75% of healthcare could be delivered virtually, and the aim at the DHB is to shift a “significant amount” of patient care into people’s homes by the end of this year.

“We could do it tomorrow,” Hayden says. “Home monitoring is there and available. We just need a change to the way the health sector operates, and is funded.”

Do we really need patients to travel to the hospital every time? Sometimes yes, many times no. Many of those appointments can be delivered in a virtual sense. – Dr Nigel Murray, Waikato DHB

WHERE TO FROM HERE?

While Netflix and YouTube may be superficial drivers of Ultra-Fast Broadband uptake in New Zealand, the picture is far broader. Cloud computing (which benefits from fibre’s low latency and high throughput), video conferencing (which is already fuelling our exports), virtual health consultations, and video school assignments are all signs of our times – and need grunty fibre broadband to work well. As, coincidentally, do our film, video and game development industries.

When in April 2008, John Key announced his Government would invest $1.35 billion in a $5 billion telecommunications industry “fibre to the home” programme, he argued the network would deliver enhanced productivity, improved global connectivity and enhanced capacity for innovation.

He said New Zealand had fallen behind its international competitors in terms of broadband, but that high-speed internet was essential for a country which was small and far from the rest of the world.

Eight years on, New Zealand is no longer behind in the broadband stakes. Matched up against projects in Australia, the US and the UK, we stack up pretty well. So much so that the Australian government senate committee looking at how to whip its National Broadband Network rollout project into shape, recently called on two Chorus leaders – head of market insight Rosalie Nelson and network strategy manager Kurt Rodgers – to give them some pointers as to how fast broadband should 
be done.

But even in New Zealand, what’s happening with the use of broadband is only a glimpse of how fast fibre – and the ability to use video – will bring fundamental change in the future – to how we teach, how we deliver healthcare, how we do business, how we run our country.

Broadband-enabled technology is moving so fast we can’t imagine what applications our children will be using in 20 years’ time, though we can be sure that pictures, whether they involve video, virtual reality, augmented reality, all of the above, or something quite different, will play a big part.

Video – powered by fast fibre broadband – is changing the way we live. Period.

This article was originally published in The Download, a publication produced by Tangible Media for Chorus.