The FCC is set to take up a vote on the hot-button issue of net neutrality this week, with much of the focus coming from tech and telecommunications companies. But healthcare leaders should be paying as close if not more attention.
As the healthcare sector tilts increasingly toward telemedicine, mobile, cloud-based EHRs and data sharing efforts, the implications of a tiered-access Internet are potentially massive.
The general debate comes down to whether a “neutral” Internet should be maintained, in which everyone can access the same speeds and services at the same costs, or whether Internet service providers can offer a so-called “fast lane” that loads some content more quickly than others.
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The vote on Thursday, though it may be delayed, is considering a proposal that would regulate broadband providers like utilities, which would give the FCC greater authority to ensure providers treat all Internet traffic equally.
Opponents of neutrality say Internet providers can likely offer a better overall web experience by negotiating deals with major content providers. However, opponents of that tiered approach claim that Internet providers, left unchecked, will tailor traffic that favors their business needs over those that don’t.
Indeed, by several accounts, the tiered approach could derail digital efforts in healthcare that have shown great promise in achieving more efficiency and patient connectedness.
“A growing number of healthcare providers, particularly in the ambulatory space, are moving towards web native EHR and practice management applications, which are hosted in the cloud,” said Nael Hafez, chief information officer at The Pediatric Physician’s Organization at Boston Children’s Hospital. “Physicians in these practices typically depend on broadband internet service providers to access their systems in order to provide care for patients in their practices, and to do things like view their schedules and write and transmit electronic prescriptions using their tablets and smartphones.
“These physicians are doing all of this over the same networks as their patients, home shoppers using Amazon, gamers on their play stations, and those streaming Netflix,” he added. “Imagine what would happen if preference were to be given over these shared networks to Netflix traffic because they are made to pay a premium by the ISP to provide prioritized, high reliability, uninterrupted connectivity for their customers?”
Despite such ramifications, the industry has largely and curiously sat on the sidelines, and the viewpoints vary depending on a range of factors and interests that can be as diverse as the field of healthcare itself. Neither the American Medical Association, CHIME nor HIMSS have taken a position. Likewise with the American Telemedicine Association.
“We’ve not taken a position,” said John Linkous, CEO of the ATA. “We have members on both sides of the issue.”
Linkous noted the loss of net neutrality could disproportionately impact newer companies. However, he said there are valid reasons to establish a tiered-access system for high speed services.
“It’s a challenge for new entrants that are worried that managing networks favors one group over the other,” Linkous said. “There are legitimate reasons why you need to manage a network, so someone doesn’t take it and shut down the network. On the other hand, there’s an important rule of thumb that everyone should be able to used the internet in the same way.”
Hafez said the matter has not been a priority for the industry because much of the focus is on large-scale provider organizations, who can likely afford to adjust to a tiered Internet model.
“Currently, most large-scale healthcare organizations depend on high-cost private networks for their operations and have limited and tightly controlled exposure to the Internet, to support remote access to their workforce as an example, due to well publicized and legitimate security considerations; the cyber attack we sustained last year being one example,” Hafez said. “They also have multiple carriers that provide them with access to the outside world, so they can control which traffic should go through which pipe and change things as needed when they see performance degradation for any reason. Thus, it’s not as important an issue as other consumer-driven sectors of our economy.”
That is decidedly not the case for certain vendors or independent practitioners.
“If you have this concept of net neutrality, it would allow for cloud-based companies to aggregate data across multiple destinations,” said Ed Park, chief operating officer of cloud-based EHR vendor athenahealth. “It will enable players like us to aggregate data on behalf of patients.”
Park added that the biggest obstacles with healthcare, data and interoperability is more political than technical, with the net neutrality debate punctuating that point. “The technology is there,” he said. “Now it’s a question of political will.”
Yet Internet service providers like Comcast, Verizon and others maintain that they would be able to offer better and faster service through negotiated deals with major content providers, and that security can more easily be maintained. They also note that as Internet usage grows, the cost does, too, and a tiered-access system would enable better infrastructure.
Opponents who are in favor of neutrality don’t buy the argument, and fear that internet providers will end up with a pay-to-play model with little oversight, leaving out smaller and less established businesses that could stifle innovation.
“That means the physicians’ data traffic would by definition get a reduced quality of service, unless they are willing to pay even more for higher tier, higher priority,” Hafez said. “The implications are increased cost of care delivery and reduced quality of services delivered. When cloud base EHRs, practice management systems, and health information exchanges are not accessible due to disruptions or poor performance related to the Internet, then physicians will not have access to the information they need at the point of care, which has significant patient safety implications as well.”
There are signs, however, that the industry has started to take note.
In January, three trade groups – Health IT Now, mHealth Regulatory Coalition and the Wireless-Life Sciences Alliance – authored a letter to the FCC, cautioning against “the unnecessary application of additional open internet requirements, or of antiquated Title II common carrier regulations, to the vibrant wireless ecosystem.”
[Photo from Flickr user Joseph Gruber]
