The Internet works fine for e-mail or casual web access but does not provide adequate quality for advanced applications such as videoconferences for education and telemedicine. This is because of the absence of any guaranteed quality and the convoluted routing of the Internet. Because most of the Northwest evolved on the periphery of the Internet, connecting from OHSU to PCC for example before NWAX required up to 29 router hops and went via Sacramento, San Jose, San Francisco and even Everett, Washington to go five miles across town. Each additional hop, and all those extra miles introduce delays and degrade quality. NWAX avoids all that by directly interconnecting participating networks. This enables members to use a common circuit to connect to many different partners and branch offices where previously each needed a dedicated circuit.

Above: Without NWAX, connecting to a server across town can require 30 router hops and travel thousands of miles. Poor local connections between these networks can degrade service and take as long as 200 milliseconds, making advanced applications impossible.	Above: Contrast this with a solid, high-quality connection via NWAX in just 10 milliseconds and as few as four hops. The Exchange makes advanced applications, like two-way video, telemedicine and high-quality distance learning feasible.

Advanced Capabilities

NWAX can improve the quality of your local and regional connections, allowing you to use advanced capabilities that do not work reliably with the regular Internet. This requires, of course that the participants each have adequate bandwidth and are connected either directly to the Exchange or by a member ISP. Without NWAX, the choices are usually to do without, accept degraded performance or lease expensive dedicated circuits.

Videoconferences. Internet Protocol (IP) videoconferences have become very popular in recent years as a way to reduce travel and leased circuits, and to foster remote relationships that were not practical before. IP videoconferences work very well when the network has adequate end-to-end performance and relatively low latency. Unfortunately, the current convoluted routing of the Internet increases the likelihood of problems and delays, particularly in most of the Northwest because our Internet connections are so far from the major Internet exchanges. NWAX changes this by directly connecting regional networks together. IP videoconferences are good for:

• Teleworking. Oregon is a world leader in teleworking. While most telework today does not use IP video, this medium can improve the quality of work relationships and participation, reduce travel and create new business opportunities.
• Telemedicine. Today, many rural communities do not have access to dermatologists and child psychologists, as well as a number of other specialties. When these services are needed, the choice is often to do without or miss a great deal of time at work and/or school in order to drive to the physician. Simple videoconferences can take the place of many face-to-face consultations. While telemedicine has been slow to take off for a number of reasons, including difficulties with insurance reimbursement, having a high quality, low cost option like NWAX improves access to care.
• Oregon has a large and rapidly growing elderly population that finds driving to the doctor difficult and inconvenient. "Televisits" may eliminate the need for many face-to-face appointments, reduce the cost and improve the quality of care, avoid exposing elderly people with compromised immune systems to contagious disease, improve the ability of the elderly to care for themselves and in these ways improve quality of life and longevity.
• Distance education. A lot of distance education is "asynchronous," meaning the students connect to remote servers when convenient rather than require all the class to be present at the same time. Live interaction with the class, however can also be very valuable for difficult subjects or groups that do not routinely use asynchronous distance education.
• Health care professionals are especially challenged to keep pace with rapidly changing science and new treatments, and often do not have time to drive long distances to spend several days away from their patients for continuing medical education. Live remote interaction featuring video from actual patients, and live access to highly qualified instructors is a tremendous training aid that improves health care.

Group-to-group interaction. Many emerging technologies and business opportunities, such as semiconductor design and manufacture, biosciences and creative services need regional critical mass to succeed. This is why semiconductor business, for example clustered in areas like Silicon Valley, Austin and Portland. Long distances between population centers and universities, however degrade the interaction and mutual support that is needed to help clusters of companies to emerge and succeed in these new business opportunities. High quality connections between participants in these business clusters as well as with universities and laboratories can be a tremendous asset to overcome distances and promote the group-to-group interaction needed to give these important emerging business opportunities the leg up they need to overcome our Northwest geography.