What the Net Neutrality Debate Means to Healthcare

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Healthcare providers and patients have a lot at stake in the fight for Internet access.
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Electronic health records, mobile medical apps, and telemedicine-these innovations and others are transforming patient care by making it more accessible, affordable, and effective. But while digital health solutions are gaining traction, the debate about whether to charge users for faster Internet speeds could impede progress in the healthcare space. As the net neutrality debate rolls on, here's what's at stake for healthcare providers, patients, and vendors.

Network neutrality puts forth the idea that Internet Service Providers (ISPs) should not be allowed to degrade access to certain websites or services, or create a "fast lane" that allows content favored by the ISP to load more quickly than other content. But as Internet usage continues to grow, someone has to pay for the infrastructure required to provide the connectivity, say ISPs.

Companies arguing against net neutrality assert that ISPs or broadband providers will be able to provide a better Internet experience by negotiating deals with major content providers. Critics have pointed out that a tiered system could allow broadband providers to limit or block websites of companies that did not pay up. It's against this backdrop that net neutrality has turned into an explosive issue.

A tiered payment system for accessing the Internet would have a detrimental effect on independent practitioners, maintains Dr. Antonio Pizarro, MD, who runs a private practice in Shreveport, LA. Pizarro specializes in obstetrics and gynecology, as well as reconstructive surgery. "Both physicians who are part of powerful, large groups or health systems and I rely equally on Internet access to provide patient care," he notes. "I should have equal ability to care for my patients as they do."

If vendors that provide electronic health records for example, must negotiate deals with ISPs, that will ultimately harm business, Pizarro continues. "The online data of a potentially preferred system should not get better service than that of its competitors for reasons dictated by ISPs," he says.

Additionally, patients increasingly access their medical records and lab reports online and physicians interact with patients through emails and video. Billing systems also rely on fast Internet access.
About 90 percent of his billing procedure relies on the Internet, according to Pizarro and sending a bill on a slow connection would disrupt his workflow.

Pizarro says he is in favor of net neutrality to "maintain a level playing field" with larger players in the health industry. Otherwise Pizarro says he will most likely be forced to join a health system, which he hopes to avoid. "I don't want the number of patients that I treat or the care that I provide dictated to me," he says. "But independent practitioners are a dying breed and if my ability to provide meaningful care is disrupted, I won't be able to overcome that."

Federal Communications Commission Chairman Tom Wheeler has been deliberating how to ensure an open Internet. The FCC could reclassify wired and wireless broadband connections as a Title II telecommunications service or common carrier, thereby allowing the agency to enact strong network neutrality regulations. This idea gained momentum in November, when President Obama urged the FCC to adopt the "strongest possible rules to protect net neutrality."

But some organizations argue that doing so would subject content providers to a wide variety of rate, quality, and privacy regulations that inhibit innovation. "Imposing public utility regulations on the broadband market will create years of uncertainty, legal challenges, and lost innovation," says Joel White, executive director of special interest groupHealth IT Now Coalition. "That will clearly distract us from what's really at stake-ensuring that broadband technology continues to enable new innovations in healthcare to enhance patient care, reduce disparities, and lower costs."

In January, three healthcare-focused trade groups, Wireless-Life Sciences Alliance, mHealth Regulatory Coalition, and Health IT Now Coalition,sent a letter to the FCC asking it not to apply these regulations to mobile broadband services.

"Regulatory and economic factors dictate against the imposition of a one-size-fits-all Title II common carrier regime on competitive and diverse mobile broadband services," the organizations write. "An arcane utility-style regulatory approach is inconsistent with and harmful to innovation in mobile health."

For several decades, high-speed cellular Internet access has been largely exempt from regulations aimed at preventing ISPs from slowing down websites and applications in net neutrality rules. But in an op-ed that was published in Wired in early February, Wheeler writes that he is submitting to his colleagues, "the strongest open Internet protections ever proposed by the FCC." The rules, which cover mobile broadband, are designed to "ban paid prioritization and the blocking and throttling of lawful content and services." Other F.C.C. commissioners are reviewing Wheeler's proposal which will be subject for a vote by the full commission on February 26.

Few healthcare organizations have taken an official stance on the issue of net neutrality, though. White says he is not aware of other healthcare organizations that have addressed the issue. And Pizarro says he was "puzzled" when he couldn't find information about the American Medical Association's (AMA) position on net neutrality. The AMA and the College of Healthcare Information Management Executives did not immediately respond to requests for comments.

Tech companies, however, are examining net neutrality's impact on their business. Stuart Bracken, chief executive officer and co-founder of Bioscape Digital, is tracking the development of the net neutrality debate. Headquartered in Atlanta, GA., Bioscape Digital provides a tablet-based platform that allows health systems to capture patient data and deliver targeted information and transaction information to patients.

Bioscape's contract with customers includes service level agreements that mandate the speed and quality at which the company delivers its platform. Changing the Internet's regulation structure could "adversely affect our ability to deliver our platform, though only to a small degree," Bracken maintains. The platform's core content comes pre-installed on the device, so the negative impact would mainly be felt in the company's ability to quickly provide software updates.

Relying on offline content is not an ideal business and Bracken is hopeful that a competitor will develop a solution that provides unfettered access to the Internet. "My personal belief is the free market results in the most consistent, best delivery of technologies," he says. "But we do have contingencies in place to ensure we are able to deliver the best service possible to our customers."

Rob Dhoble, the chief executive officer of Adherent Health, which offers mobile app-based services like medication management and mobile health diaries, also hopes that an alternative solution will surface. A dangerous situation would be for carriers to propose "free Internet service and make money in gain-share agreements with its monopolistic franchise partners," Dhoble maintains.

Such an approach may attract a price-conscious audiencethat's willing to trade quality for a free service. "Free could be the Trojan horse," Dhoble says. [But] "my hope and bet is thatthe free market will rule,Wi-Fi will encroach upon the wireless carriers' stranglehold, [and] smart senators of both partieswill step upand propose legislation that preservesinterests of many existing at-risk businesses."

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