Often the techspeak of Silicon Valley amounts to little more than overly complicated descriptions—jargon, designed to pique a reader’s interest in purchasing the latest gadget:

“This next-generation hyper-notchifier (revision 6.u) is sure to make your clinic the envy of the hospital staff.”

“Net neutrality” may be another combination of confusing words sure to make everyone want to look the other way, but it’s a pertinent issue worth understanding. It may not, at first glance, seem relevant to the day-to-day lives of healthcare workers, however, it reaches far beyond the walls of Congress and deeply into our lives today and into the future. The intent in writing this article is to clarify the concept of net neutrality and its impact on modern healthcare.

Net neutrality describes the regulatory protections that prevent Internet service providers (ISPs) from sending online data through the pipe at different rates depending on who is paying, and how much they pay. This is different than the types of payment for accessing the different endpoints of the internet like we all go through monthly subscription charges for internet in the home of office.

The previous policy was to treat internet data as we did calls across telephone lines: everyone’s calls had equal priority, and the connecting wires were considered common to all users. With today’s ability to identify different types of data and usage, there’s a new opportunity to extract more profit from senders and receivers based on their importance, which is the position of the carrier companies and our service-fee-enriched Federal Communications Commission (FCC).

Imagine the US Postal Service charging different amounts to deliver a package based on what’s inside the box and who’s sending it, rather than charging everyone equally based on the package’s weight. In 2015, Congress established a set of regulations which ensured net neutrality and it was decided that the FCC should have the final word on future decisions. At this time, the FCC is reevaluating the concept of net neutrality and considering rolling back many of these protective regulations.

Streaming video content is a prime example of a system which uses lots of “data pipe” space and is often targeted by the ISPs to be “throttled,” or streamed at altered rates unless the consumer makes an additional payment. In the future, throttling might come to include premium fees on important medical records or lab results.

The White House has voiced its support of the rollbacks. Press Secretary Sarah Sanders, on July 19, said: “The previous administration went about this the wrong way by imposing [net neutrality] rules on ISPs through the FCC’s Title II rulemaking power…We support the FCC chair’s efforts to review and consider rolling back these rules and believe that the best way to get fair rules for everyone is for Congress to take action and create regulatory and economic certainty.”

The perspective of the White House and the FCC is that regulation has restricted growth of ISPs and hurt their profits. In an industry that is already heavily subsidized by the federal government, with AT&T receiving $428 million in 2015 to provide 10Mbps internet to rural America (AT&T then complained that they shouldn’t have to provide speeds that fast). With combined revenues of over $100 billion in 2016, one wonders how ISPs like AT&T, Comcast, and Verizon are being hurt by regulation.

Several large tech companies, such as Netflix, Twitter, Facebook, and Google, have already voiced strong opposition to rescinding the current net neutrality rules. The Internet Association, in its filing with the FCC, stated that if the FCC does reduce net neutrality, it will “create significant uncertainty in the market and upset the careful balance that has led to the current virtuous circle of innovation in the broadband ecosystem.”

Why Does Net Neutrality Affect Healthcare?

The majority of electronic health records (EHR) software technology uses cloud storage to provide medical practitioners and patients with quick and easy access to medical data. Since this technology operates through the internet, a high-speed connection is vital to its use. The investment that the medical community has made in EHR technology through government programs like Meaningful Use and MACRA carried the notion of technology as a means of improving healthcare. The perception was that the technology delivered efficiency as well as convenience.

The rollback would result in even higher costs to the healthcare IT organization, which is already paying to store vast amounts of medical data online. Without net neutrality regulations, ISPs would be free to charge health organizations to access that data, which would raise administrative costs and reduce the efficiency of healthcare.

Other advances in EHR technology like telemedicine function completely online with patient and provider portals, email, and video consultations to provide medical treatment to people in underserved/rural areas. Likewise, interoperability between different EHR systems strengthens channels of communication between different medical facilities and makes healthcare data more accurate and efficient.

Furthermore, supposing two facilities have two different ISPs, their ability to mutually access the same content would be affected. This would make interoperability between EHR systems in different locations difficult, which in turn would reduce the quality of care for patients who go to one location for primary care, and another for specialty care.

The concern within the medical community that eliminating net neutrality will adversely affect healthcare (mobile/telehealth in particular) has been recognized. In 2015, Health IT Now, mHealth Regulatory Commission and the Wireless Life Sciences Alliance sent a letter to the FCC Chairman, at that time Tom Wheeler, emphasizing the importance net neutrality for the healthcare industry: “ The undersigned…ask the Commission to maintain the structure for wireless services adopted in the 2010 net neutrality rules that has allowed the burgeoning mobile health industry to grow and succeed… the country has made significant investments in the creation of a nationwide health information network through the creation of regional health information exchanges laid out in the HITECH Act.” The letter goes on to say that “the wrong regulatory rules could inhibit or greatly delay needed network investment and innovation that will be critical to next-generation health solutions,” including reduced latency, improved quality of service, and machine-to-machine interfacing opportunities.

Since the inception of the internet, many public services have developed entire infrastructures dependent on internet connections. EHR software requires high-speed internet to provide the quick and easy access to health records in order for medical providers to work effectively and efficiently. Without net neutrality, healthcare would halt in its progress towards improved patient outcomes, because the use of internet-based tools and applications would be limited by higher costs and hindered access. A hasty decision to roll back net neutrality would have a direct, most likely negative, impact on healthcare for those most in need: low-income patients and those in rural, underserved locations.

The FCC must review all of the unintended consequences of the rollback of 2015’s net neutrality laws, and see beyond the urging of ISPs to affirm longstanding “common carrier” ground rules for the common good, today and the future.

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