                     Innovative Services Delivered Now

        ISDN Applications at Home, School, the Workplace and Beyond

                               January 1993

Introduction

Since October, 1991, the Electronic Frontier Foundation has been advocating
a practical, incremental approach to modernizing the telecommunications
infrastructure.  Calling for an "open platform" for innovation in
telecommunications modelled on the success of the personal computer in the
1980s, EFF has sought to develop a consensus for the widespread deployment
of the "Integrated Services Digital Network" (ISDN).1 ISDN Open Platform
service will enable personal and small group communication for residential,
non-profit and small business users.

ISDN enables the telephone network, which was built for traditional voice
calls, to carry far more information at higher speeds and without the
errors of the traditional analog system.2 As a result, ISDN can deliver a
wide range of desirable applications in education, healthcare,
telecommuting, videoconferencing and multimedia, and home energy
management.  In light of this substantially increased functionality, EFF
believes that ISDN can be the telecommunications analogue to the Apple II
or early IBM PC: a widely available, reasonably priced open platform that
offers a critical mass of features and thus enables the development of
scores of new applications.

EFF has collected information and analyses to test the Open Platform
proposal.3 We believe that evidence supports our position that ISDN can be
tariffed affordably enough to position it as a "mass market" service.4
Based on public commitments made by the Regional Bell Operating Companies
(RBOCs), nearly 60% of telephone access lines nationwide will be served by
the necessary digital infrastructure for ISDN by the end of 1994.5
Knowledgeable executives from the telecommunications and computer
industries have publicly expressed support for the ISDN-based "Open
Platform" approach to network modernization.6 And consumer groups, which
have traditionally opposed telecommunications modernization efforts,
support this "narrowband" approach because it allows those who want
enhanced functions to get them at a reasonable price, without burdening
other ratepayers with the costs of unwanted services.

However, the potential of ISDN remains unclear to many observers because
they are unaware of what services can be provided over it.  Indeed, despite
the fact that ISDN has been under development since 1968, applications have
been slow to develop.  In the U.S., this was exacerbated by the divestiture
of the Bell Operating Companies from AT&T, which created seven large local
service providers, the RBOCs, in place of a centrally coordinated,
vertically integrated, monopoly provider.  Although every RBOC (and many
non-Bell companies) offered ISDN on a limited basis in a handful of areas
starting in the mid- to late 1980s, any one company's ISDN could not
connect to or interoperate with any other company's version of the service.
 As a result, the growth of applications was stymied by the lack of
standard protocols and the resulting small markets.  In a classic
"chicken and egg" conundrum, the service languished because potential
subscribers could not identify useful applications, and applications
developers saw little opportunity in ISDN because the market was not yet
in place.  And just as few would be likely to subscribe to "550MHz of
analog signal transport over coaxial cable" in the absence of cable
program services such as HBO or CNN, ISDN has had few takers in the
absence of identifiable applications that can be delivered through this
technology.

Nevertheless, ISDN-based services have been created and are being offered
today.  Through trials by US providers, the extensive deployment of ISDN in
other countries (most notably, France, Japan, Singapore, and, to a lesser
extent, the U.K.), and a developing interest in related technologies for
use in private networks or over leased lines, a variety of applications can
be identified that take advantage of the digital bandwidth that ISDN makes
possible.

EFF believes that many of the functions most often described by proponents
of advanced telecommunications networks can be delivered over ISDN lines.7
The following report identifies a handful of representative examples of
what is being done today with the bandwidth and functionality that ISDN
offers.  It makes no claim to be a definitive listing of all those services
currently available over ISDN.  Instead, the paper will focus on selected
applications in those areas most often discussed by proponents of
infrastructure modernization: telecommuting, health care, distance
learning, video conferencing, etc.8 While ISDN can not offer all those
services foreseen in the broadband networks of the future (e.g., high
definition television, high-speed packet switching, or high resolution
interactive multimedia), many services can be provided today over the
narrowband facilities that ISDN offers.9

Finally, despite the many working applications described below, EFF expects
that the most exciting and innovative applications remain to be developed.
Just as the existence of the Apple II and the PC led to the independent
development of applications the hardware manufacturers and the public never
imagined, EFF believes that widespread availability of ISDN as an open
platform will create a fertile market that entrepreneurs will rush to seed
with new applications.10 The independently developed application that
creates a whole new genre or market - the "Pagemaker" or "Lotus 1-2-3" of
telecommunications - will not appear until the platform is available.

The Changing Context for Applications

The perceived desirability of ISDN is growing because the technological and
social context for evaluating it has rapidly evolved.  Perhaps most
dramatically, the widespread availability of PCs has created an installed
base of devices through which users can realize and enjoy many of ISDN's
benefits.  Moreover, computing technology is becoming faster, cheaper, and
more powerful, while many people are becoming accustomed to increasingly
sophisticated computers and telephones in their offices or at home.  These
two trends - more powerful and inexpensive computing tools and assimilation
of increasing levels of computer technology in daily life - are creating a
new interest in ISDN.

A.  Technology Gains Deliver More Power to Users

There is no set of applications that inhere in ISDN.  ISDN merely offers
transmission capacity of a specified type, with a standard set of call
control and capacity-management functions.  The uses to which that managed
capacity can be put are constantly expanding due to three inter- related
trends: 1) dramatic gains in computer processing power; 2) rapidly falling
costs for equivalent computer functions; and 3) substantial advances in
compression, which allow an ever-greater amount of information to be
squeezed through the same line.  As a result, new services are being
developed that push the envelope of what can be done with ISDN's 144,000
bps of digital capacity.

Both research and anecdotal evidence suggest these trends toward greater
efficiency and creative use of bandwidth will continue, so that cost-
effective means for delivering applications heretofore thought to be
"impossible" over ISDN will continue to be found.

For example, a recent analysis of computer performance per $1000 spent,
based on desktop and laptop computers from 1983-1991, found that every year
the same $1000 will purchase 47% more CPU capacity than the year before,
52.4% more memory capacity (RAM), and 115.2% more disk capacity.  These
trends are projected to continue.11 A similar study of larger computer
systems supports the finding.12 Thus, through steady gains in computing
efficiency, speed, power and memory, the amount of computing intelligence
available to the end-user is both growing and becoming more affordable.13

The increased efficiency of computer components and their falling costs
have clearly discernible effects on what can be done with ISDN.  In 1992,
Dr. Robert Lucky, then the Executive Director of AT&T Bell Laboratories'
Communications Sciences Research Division, noted that video-windows on PCs
over ISDN is emerging now because of the development of cheap bandwidth,
significant improvements in video compression and the recent availability
of low-cost video equipment.14 Executives at the British subsidiary of
PictureTel, a leading U.S.  manufacturer of videoconferencing equipment,
estimate that prices for comparable videoconferencing services are cut in
half every two years.15

B.  A Revolution of Rising Expectations

The other significant trend that shapes the context for applications is the
growing use of and familiarity with increasingly powerful personal
computers and on-line information services in businesses, schools and
homes.  The percentage of U.S. households with a PC has grown by 10
percentage points every five years since 1980, when they first became
widely available;16 over 25% of all homes and small businesses now have
them, as do half of all medium-sized businesses and almost all large
businesses.17 According to a recent estimate, the dial-up modem business is
currently growing by 25% a year,18 which suggests a fast growing demand for
on-line services and computer-based communication over the public network.
The use of electronic mail is now widespread among Fortune 2000 firms, and
by 1990, there were an estimated 12 million users of these services in the
U.S.  The Internet, an international network of networks connecting
academics, government workers, employees in the commercial sector and
others, is estimated to be adding hosts at the rate of 15% per month.19

More and more people have come to depend on file servers, networked
applications over local area networks (LANs), voice mail, and even
videoconferencing at their offices or in their professional lives.  Today,
more than 30% of all PCs are equipped with communications capabilities, and
the majority of business computers are already attached to networks.20
Sales of U.S. office system LANs have grown from approximately 12,000 units
in 1990 to almost 35,000 projected for 1992; shipments of routers, LAN
interface cards and servers have similarly taken off since 1990.21 Recent
forecasts predict that well over half of all PCs in the U.S. will be
attached to LANs by 1995.22 The growing need to connect these LANs has
stimulated interest in cost- effective networking options, especially those
available through the public switched network.23

Finally, with graphical user interfaces (GUIs) becoming increasingly
common, as Apple's Macintosh is joined by Microsoft's Windows and IBM's
OS/2, bandwidth demands are growing to perform the same functions.  These
GUIs make greater information demands with their full color images,
multi-fonted text, and more complex output, such as desktop publishing
documents.  As a result, traditional applications like electronic mail, as
well as newer applications, such as screen sharing, will require a step up
in bandwidth simply to stay the same from the user's perspective.

Applications in Education/Distance Learning

Distance learning refers to "the linking of a teacher and students in
several geographic locations via technology that allows for interaction."24
It was initially designed to extend educational resources into
geographically remote or rural areas, but interest has grown in using the
technology to share scarce resources in urban areas as well as to meet the
needs of students who cannot reach traditional classrooms.  Researchers
have concluded that distance learning facilities overcome more than simply
distance.  According to a recent study, the top three reasons that students
report enrolling in television-based distance learning courses at the
college level are time constraints, work responsibilities, and family
responsibilities.25

The prohibitive costs associated with many distance learning programs have
kept these benefits from reaching a wider public, however.26 Distance
learning programs are usually based on instructional programming delivered
by satellite or through an Instructional Television Fixed Service (ITFS)
network.  Both methods require expensive equipment at the school and in the
delivery system, and both allow for only limited interaction between
teacher and student or among students.

Recent efforts to conduct distance learning over ISDN have been successful.
According to a recent report, "ISDN offers students and teachers in
distance learning programs an interactivity level not available in ITFS or
satellite programs without adding to the cost of the program."27 For these
and other reasons, the researchers concluded that:

"ISDN has proved extremely efficient and effective technology for on-
demand delivery of educational services to any region offering digitally
switched phone service."28

The following examples suggest that ISDN is a viable, effective technology
for distance learning, with shared workscreens, video-conferencing, and
access to off-site resources in many settings.

o       California State University, Chico, in partnership with AT&T and
Pacific Bell, has completed two successful trials of ISDN as a delivery
system for distance learning.  In May, 1992, ISDN was used to link
fifth-grade classes in three elementary schools in the Chico area.  During
the trial, students shared slide show presentations and participated in
conference calls that included video, data, and image transmissions.
Through this system, students and teachers were able to engage in
real-time, interactive, two-way audio and video communication, view a
laserdisc video clip display, and send and annotate graphic images or
text.29

o       Appalachian State University, AT&T Network Systems, and Southern
Bell have built an ISDN-based distance learning network that delivers
interactive voice, data and video to three North Carolina schools.  The
10-year project, called "Impact North Carolina: 21st Century Education,"
was touted as "one of the first in the nation to deliver interactive video
instruction through existing copper phone lines."30 The system transmits
interactive voice, data and video at 112,000 bps to two elementary schools
and one high school in Watauga County.  The Impact North Carolina system
will give K-12 students access to remote lecturers, university libraries,
and other distant resources, and will also be used to improve teacher
training, student teacher supervision, and continuing education at Reich
College of Education, a major regional center for educating teachers.31

o       Project Homeroom, an initiative "designed to improve student
thinking, learning and computing skills,"32 is a partnership among six
Chicago area schools, Ameritech, IBM, Illinois Bell, Prodigy, AT&T Network
Systems, Central Telephone Co., and Eicon Technology Corp.  Over 550
students are participating in the project, which uses PCs, multimedia
software with CD-ROM, video, voice and text features, and on- line services
over phone lines supplied by Illinois Bell.  Students access on-line
homework correction, instruction and tutoring, and computer communication
with teachers, among other features.  Seventy-six of the participating
students from Stagg High School in Palos Hills, Ill., use the system over
ISDN.  ISDN allows these students to exchange text, pictures and
calculations up to 8 times faster than other students.  Initial
observations indicate that the homes outfitted with ISDN links are on line
four times more than those with analog phone service.33

o       In Nashville, Tennessee, students at Carter Lawrence Middle School
and Meigs Magnet Middle School can work together and with the Learning
Technology Center at Vanderbilt University over ISDN.  The pilot project, a
joint effort of South Central Bell, Northern Telecom, Vanderbilt and the
Tennessee Public Service Commission, uses voice, video and screen sharing
technologies to enable students to see and talk with other students or with
faculty at Vanderbilt, as well as share documents, graphics and other
information.34

o       In the Research Triangle Park area of North Carolina, the North
Carolina State University Center for Communications and Signal Processing,
BellSouth, Southern Bell, GTE, IBM, Northern Telecom, and the Wake County
Public School System are developing SCHOOLNET, "a project to demonstrate
the enhancement of public education through advanced telecommunications
technologies, specifically ISDN."35 Among the functions that SCHOOLNET
plans to provide are video learning and distant instruction; electronic
access to library materials; faculty support for exchange of curriculum
materials and teaching aids; and administrative support for scheduling and
staffing purposes.

ISDN could also enhance the availability and value of educational resources
on the horizon.  Congress has passed legislation calling for the creation
of a "National Research and Education Network" (NREN), to link "educational
institutions, government, and industry in every State."36 Among its
purposes, Congress sought "to promote the inclusion of high-performance
computing into educational institutions at all levels."37 The investment
needed to actually connect every one of the nation's 84,500 public schools
and 24,000 private schools is far beyond the resources available in the
NREN legislation.  If ISDN was widely available, it could substantially
leverage the value of the government's investment by enabling schools,
especially at the K-12 level, to attach to the NREN and reap the benefits
of this high-performance network.

Applications in Health Care

Many analysts have suggested that advanced telecommunications networks can
have substantial benefits in improving the delivery and reducing the cost
of health care services.38 While the publicity often focuses on medical
consultation from home and remote diagnosis, other applications in the
health care field include reducing administrative costs, providing health
and medical information to help people take better care of themselves and
make more informed decisions about their medical needs, providing health
care in rural areas, and enabling doctors to consult with one another.39

Medical images are often especially dense with information, and the
reliability of their transmission is paramount.  A typical CT scan image
contains about 5.2 megabits (Mb) of information, while a digitized X-ray
requires 12 Mb of information.  While both CT scan images and X-rays can be
sent over phone lines today, the process is slow: A single CT scan takes 9
minutes, and an X-ray 21 minutes.  Using just one B channel of an ISDN
line, those times can be reduced to 1.4 minutes and 3 minutes,
respectively.40 Of course, by combining the two B channels of an ISDN line,
those times can be cut in half again.

o       The U.S. Public Health Service is facilitating the development of a
multimedia telecommunication network for coordinating community health and
human services and promoting shared group decision making for better case
management.  The Community Services Workstation will combine video-
conferencing, document sharing among remote health care and social service
workers, and access to databases with medical information, local services,
and practical information that can be produced for clients such as maps and
mass transit routes.  Based on prototype research completed by Dr. Anthony
Gorry at Baylor University, the workstation now being tested at Howard
University in Washington D.C. is built on PCs connected via ISDN.41

o       In Huntsville, Alabama, BellSouth and the U.S. Army have created an
ISDN lab to develop voice, video and data applications for the Army,
including medical applications.  Dr. Ira Denton, Jr., a neurosurgeon with
The Alabama Back Institute, has demonstrated how ISDN can support remote
consultation during surgery.  In this scenario, a remote specialist, linked
with simplex video and full duplex audio, views the operation through the
operating microscope, getting the same view of the procedure as the surgeon
on site.  ISDN also enables post-operative follow-up exams of patients at
remote locations.  The exam can be performed by a nurse-practioner under
the remote guidance of the surgeon, who has full video and audio contact
with the exam site.42

o       The General Computer Corporation, a company that processes claims
for insurance and state benefit programs from pharmacies, doctors' offices
and hospitals, recently announced that it would begin using ISDN for claim
processing and membership verification services in Pennsylvania.  ISDN will
significantly reduce transaction time and telecommunications charges.
Currently, a routine authorization from a pharmacy or doctor's office takes
over 30 seconds; with ISDN, the same procedure can be cut to under eight
seconds.  General Computer projects that over 25 million pharmacy
transactions are carried each year over the public network, and that the
switch to ISDN can cut response times on claims by up to 85%.43

o       The U.S. Department of Veteran's Affairs (VA) Information System
Center at Silver Spring, Maryland, is testing how ISDN can extend access to
the VA's medical imaging and document imaging system.  The VA's integrated
imaging system stores medical images, including pathology specimens,
X-rays, cardiology studies, and endoscopy views, in addition to the
text-based patient information system available at all VA medical centers.
The VA is using ISDN, configured to combine the two B channels for data
transfer, to link the VA center at Silver Spring, the VA medical centers in
Washington, D.C., and Baltimore, Maryland, and the NIST campus in
Gaithersburg, Maryland.  According to preliminary reports, the system can
retrieve a 750 kilobyte, 16 bit color image from the image server over ISDN
in 60 seconds.44

o       The University of Louisville, the State of Kentucky Cabinet for
Economic Development, and South Central Bell have created the
Telecommunications Research Center ("TRC") at the University's Shelby
Campus.  The TRC recently demonstrated the transmission and reception of
dental images using RadioVisioGraphy ("RVG"), a filmless dental x-ray
system, over ISDN connections between the TRC and Washington, D.C.  TRC
forecasts uses for remote consultations for diagnosis, referrals, and
