Net Neutrality is the set of FCC rules enacted in 2015 that prohibits internet service providers like AT&T, Comcast and Verizon from speeding up, slowing down or blocking any content, applications or websites. The rules prohibit ISPs from entering into agreements with certain content providers that guarantee faster load times or from charging customers more for the speedy delivery of particular content. The new Trump administration chairman, Ajit Pai, wants to see these rules eliminated. On May 18, the FCC voted to move forward with the plan to undo Net Neutrality. So, how does the loss of net neutrality affect telemedicine?
In 2015, the Obama administration enacted the “Open Internet Order” which banned ISPs from blocking or throttling (slowing down) any legal content. It also prevents them from allowing content providers like Netflix, Amazon, and others to pay a to have their traffic prioritized. Additionally, it gives the FCC the authority to police other practices it believes are unreasonable or harmful to consumers.
Internet users from consumers to businesses and the media are worried that if the FCC eases up or eliminates these rules, the result will be a “fast lane” that comes at a steep cost to users, and a slow lane with a poor or even unworkable user experience.
What does this mean for telemedicine?
There is great concern among net neutrality proponents in the healthcare community that rural and underserved communities with fewer options for ISPs will face slower speeds and higher costs, than their counterparts in more affluent communities, resulting in a lower quality of care for these patients.
Telemedicine would be directly impacted by these plans, possibly interrupting the surge in use of this exploding new channel for healthcare delivery. Experts predict that 7 million patients will benefit from telemedicine by 2018, but the loss of net neutrality puts this growth at risk. If the rules are changed, ISPs would be able to charge additional fees to health care providers for access to high-speed audio and video connections. In all likelihood, these costs would be passed on to patients, creating yet another barrier to health care for the populations that need it most.
The Experts Weigh In
The American Academy of Pediatrics stated, “It is the AAP’s position that an Open Internet is a vital component in assuring access to health care for children and their families. As such, AAP is opposed to the implementation of paid prioritization because of its detrimental effects on the elimination of health disparities, the efficiency of healthcare, and access to health information by parents and caregivers.”
In a post for Health Affairs Blog, a group of researchers from St. Louis University, the Medical University of South Carolina and Harvard University wrote, “Increasingly, telemedicine is being used to bring higher-end health care services to remote and rural areas to reduce health disparities. For telemedicine to be scalable and positively impact cost and outcomes, there must be a predictable infrastructure connecting patients, care providers, and technology. A prerequisite for telemedicine is broadband connectivity between telehealth sites. Reliable low-cost service for telehealth is potentially threatened by the loss of NN. What happens to telehealth if Netflix traffic is preferred above medical applications? Could Internet Service Providers (ISPs) offer better services for one hospital system than another, helping them take over telehealth in a region? The undoing of NN weakens the infrastructure of reliable low-cost connectivity that telehealth systems depend upon.”
The rollback of net neutrality rules may have specific consequences for communities of color. Writing for The Hill, Christy M. Gamble, JD, DrPH, MPH, Director of Health Policy and Legislative Affairs at the Black Women’s Health Imperative said, “Weakening access to telemedicine could significantly impact management of health conditions that disproportionately affect communities of color. For example, African Americans with diabetes are two to four times more likely to suffer from complications from the disease, and people of color are two to four times more likely to die from it. Repealing net neutrality rules will compromise access to quality and affordable care for vulnerable communities because it will shut them out of a healthcare system moving toward innovation.”
According to an analysis by global professional services company Towers Watson, telemedicine has the potential to deliver more than $6 billion a year in healthcare savings to U.S. companies. The demise of the open internet threatens to eat into that savings, result in reduced access to needed care, and disproportionally impact already struggling communities. We hope that the FCC reconsiders its actions in light of these most certainly unintended potential consequences.