What would the end of net neutrality mean for healthcare?
The Federal Communications Commission hasn't yet overturned existing net neutrality rules, but the Republican-led agency is widely expected to soon.
Even ardent supporters of rules to ensure web traffic isn't subject to preferential treatment by internet service providers seem ready to throw in the towel on the fight, including Netflix CEO Reed Hastings, whose company (along with Google, Facebook and many others) has long fought for stronger regulations on ISPs such as Comcast, AT&T and Verizon.
"I think Trump's FCC is going to unwind the rules, no matter what anybody says," said Hastings on Wednesday, according to the Washington Post. "That's going to happen, and then we get to see what's going to come out of that."
What comes next wouldn't just affect Hastings, who clearly has vested interest in ensuring Netflix video content can stream without a hitch.
There are bigger questions about what a reversal of net neutrality rules could mean for healthcare – especially for areas such as telemedicine, remote monitoring and health information exchange.
More than ever, the internet is essential to care delivery. Just this past week, the American Medical Informatics Association sent a letter to the FCC, urging it to count access to broadband as a key social determinant of health when developing its policies.
"FCC has a critical role in ensuring that Americans benefit from the electronic health infrastructure that was initiated with the passage of the HITECH Act and supported by the 21st Century Cures Act," said AMIA officials said, noting that the agency could do better at enabling online tools to help manage chronic conditions, for instance, or combat the opioid epidemic.
A new article in Health Affairs airs similar concerns about "telecommunications policies that may significantly impact the delivery and pace of innovation in healthcare."
Its four authors – health researchers and technologists at Saint Louis University, Medical University of South Carolina and Harvard – argue that the internet "has basically become a public good" by now, and say the idea that "big telecom giants should be allowed to treat their business partners more favorably than other companies" could be detrimental to healthcare.
Specifically, allowing adherence to net neutrality principles to become voluntary could put people, "particularly those at risk for health disparities due to low income or rural residency," at risk, they said.
A tiered system for digital traffic could impact everything from telemedicine deployments to the use and utility of wellness apps to "cost effective scalable sharing of healthcare data."
For telemedicine to work well, "there must be a predictable infrastructure connecting patients, care providers and technology," they added. Robust broadband connectivity is essential, but rolling back net neutrality "weakens the infrastructure of reliable low cost connectivity that telehealth systems depend upon."
Remote monitoring and connected sensors could also be affected. For example, the set-top boxes most consumers rent from their cable ISPs offer a "constantly connected backhaul for smart, connected medical devices," according to the authors.
"But, development of an ecosystem of devices connected to the set-top box requires an open architecture, not the proprietary model favored by most cable vendors," they said. "It is simply not economically feasible to develop medical devices for each cable system. The open set-top box could provide that one point of access for health data and communications in the home, but this potential is threatened."
Finally, interoperability among electronic health records could be stymied by lack of net neutrality enforcement, the authors said.
"EHR systems are increasingly moving to cloud based platforms that require high speed connectivity. High-speed backhaul connections also are important for users with large amounts of data, such as rural hospitals for remote radiology and pathology applications in addition to other telehealth services."
Especially in rural areas, the options for online access may be limited. Localized monopolies could potentially allow ISPs to charge connection fees to small hospitals..
"A thoughtless move toward free enterprise on the Internet could have a negative impact on the health of the most medically underserved Americans," they said. "We urge the FCC to investigate the unintended consequences of policy changes to insure that they do not amplify issues of health disparities in lower income and rural populations."