Expanding telehealth activities through increased broadband penetration in rural and remote communities won't happen without direct government involvement, according to the telecommunications sector."There is no business case for us to connect these communities," Shawn Hall, a spokesperson for Telus Corp., tells Network Letter. "They are too small and too challenging for us ever to earn back our investment. It may often mean running many kilometres of fibre-optic cable through geographically challenging areas to serve a small number of households and businesses. It's not economical for us to serve , but we can do this in partnership with government and the communities themselves."Proceeds from the spectrum auction and money in the deferral accounts represent opportunities to work together to devise a solution to connect rural Canada to broadband Internet, he added.Hall pointed to Telus' collaboration with the BC government under the initiative Connecting Communities where the company invested $110 million to connect 117 rural communities in the province in exchange for extension of contracts with the government. "One of the aspects of this was better access to health services and educational services," noted Hall.As has been previously noted in Network Letter, there is government money available that could be used for broadband expansion to support a wide range of activities including telehealth. The most notable is the $4.25 billion raised from the Advanced Wireless Services (AWS) spectrum auction that took place earlier this year. And while the government has yet to make a decision on what to do with the money, some have called on the feds to allocate anywhere from $1 billion to $ 2 billion to take broadband deeper into rural and remote Canada. Use of the telcos' deferral accounts is currently on hold pending an appeal to the Supreme Court of Canada.While telcos advocate government-private sector partnerships as the only way to extend broadband to rural and remote regions, the healthcare industry contends the service providers - both telcos and cablecos - could be doing more."They definitely do have a role," says Jane O'Heir, a group program director with the not-for-profit agency Canada Health Infoway (CHI). "They need to look at the needs in the northern areas, and start funding some of that and building some of that infrastructure without looking necessarily at a huge return on investment (ROI). Those areas need those services, and we won't get anywhere until we get that ."While O'Heir acknowledges that laying pipe in the country's hinterland to support broadband communication services is cost prohibitive, telcos and cablecos should explore alternative funding models to obtain their ROI."The telcos get ROI and have good business cases in other communication services, so there may be a bit of give and take on their part for this to happen," she says. "It will open the door for increased communications where they might make some money. They will get the money from the data transfer."CHI recognizes that network owners can't go it alone. Other stakeholders, both federal and provincial governments, can get involved to further develop the necessary infrastructure, O'Heir adds.Telehealth is not only about providing medical care over great distances, it's also about teaching medical personnel new procedures using live video demonstrations for example, and high-capacity broadband pipes will go a long way to enabling this. Increasingly sophisticated telehealth applications will become available in the future, such as assisted robotic telepresent surgery (ARTS). Telepresent surgery is a leading-edge technology and relatively new field of telemedicine that uses either satellite networks or fibre optics to transfer information.But most remote and rural areas don't have access to advanced surgical techniques, a point that was made at the recent meeting of the Canadian Society of Telehealth (CST). With appropriate broadband infrastructure in place, more telementoring and telelearning can be achieved where specialist physicians like surgeons can teach more advanced skills to health providers in remote areas.New business model for telehealthWhile the business case for extending broadband to remote regions isn't strong, Richard Scott, a past president of the CST, stressed there is huge potential demand for home telehealth from an aging population and a growing number of people with chronic diseases.He added that telehealth would be more frequently used if vendors offered healthcare facilities an incentive to deploy telehealth applications, such as preferred rates. Government would also need to be on board to grow telehealth projects to be larger in scale."We know that there is a lot of excess capability in the communications infrastructure," said Scott, an assistant professor in the global e-health and training program at the University of Calgary. "If they gave the health care industry a huge break in terms of the cost of communications technology, people would say ‘it is a wonderful way to do this.' Telehealth is not of sufficient maturity to prove itself, and we are trying to create an artificial situation within which it will prove itself," he said. "Demonstrating it, proving it to people, and getting them on side is difficult to do."