It seems to me that no one in the healthcare world and particular patient advocacy is paying attention to net neutrality. Perhaps this is because net neutrality is a newer concept and potentially confuses many. But, the future of net neutrality will have a significant impact on healthcare, particularly as we focus on digitalizing the industry – from apps to manage our health to medical records to simply being able to search for information on our conditions. Much like many were not paying attention to the implications of the recently signed into law provisions that allow our internet service providers to sell our data until it was passed, this is something we cannot let slip under the radar.
So here’s a brief primer on net neutrality basics, why it matters in healthcare, and actions currently being taken to end net neutrality.
Definition of Net Neutrality:
Network neutrality is the idea that internet service providers (ISPs), including cable companies like Time Warner and wireless providers like Sprint, should treat all internet traffic equally. It says your ISP shouldn’t be allowed to block or degrade access to certain websites or services, nor should it be allowed to set aside a “fast lane” that allows content favored by the ISP to load more quickly than the rest.
What this means in reality is, any site gets the same speed/bandwidth to reach you. In other words, when you go online and you pull up disney.com or a movie on Netflix or an obscure blog about health as a human right or a health app interface, you will get to us at the same speed.
Without net neutrality, Disney or Netflix can pay an internet service provider like Comcast to get faster access. In other words, you can load disney.com or Netflix faster than you can load this blog. Disney gets to the head of the line, it comes up first and fast. The rest of us are stuck in the back of the line waiting our turn on the internet highway.
Why have Net Neutrality:
The internet has been a place where we have allowed the democratization of ideas. From it’s start, we have all had the opportunity to contribute to the internet and have an equal impact. Granted, as search engines like Google have come into play who specifically take money to highlight certain sites this equal impact has taken a hit. But the principle still remains – it’s a playing ground where everyone gets to play.
Without net neutrality, the internet fundamentally changes and become nearly all pay for play. And this has implications for not only access to information and the ability for a blogger to get their information out, but for the increasing digital divide, for the provision of healthcare, for innovation in healthcare, and for healthcare privacy.
As Tim Woo, a scholar at Columbia University put it: without net neutrality the internet will become “just like everything else in American society: unequal in a way that deeply threatens our long-term prosperity.” (cited here)
Net Neutrality in Healthcare:
Imagine this scenario, you are in a bad accident in a rural community. You get to the small, poorly funded hospital and the hospital tries to pull up your health record (this scenario assumes the because of meaningful use the hospital does have the capability to use electronic health records and with increasing interoperability they can pull up yours – big assumptions but just go with it). However, this hospital and the electronic health record system they use aren’t big players so they can’t afford to ask Comcast to pull up the records first. Nope, Facebook comes up faster. Where seconds matter, your records are waiting for someone to check their status on Facebook.
Or imagine this, you get a new glucose meter from an innovative startup to test your blood sugars. The meter connects to an app on the internet that you and your doctor can access. But when you go to the endocrinologist, it takes forever to pull up the app because someone is on Netflix watching the latest season of Fuller House. Doctors don’t have time to wait, your appointments are already time-limited and your data is now waiting to get through when you need access now.
Or say you are trying to access a telehealth app that allows you to consult with a nurse or therapist but instead of being able to connect with your healthcare provider, a person on HBO Go gets to watch Game of Thrones.
Or another example, you are trying to connect to a small non-profit’s website to get information about your rare disease, information that can’t be found easily anywhere else. You might have to wait while someone else is booking their Disney vacation.
Granted, when the net neutrality rules were put into place, there were exceptions such that the rules “can have clear, monitored exceptions for reasonable network management and for specialized services such as dedicated, mission-critical networks serving a hospital” (cited here). But I’m not sure that has actually panned out or created any help for hospitals. And it certainly doesn’t help the innovation of startups, the small non-profits, or the telehealth community among many many other aspects of healthcare it might affect from health information exchanges to doctor’s practices to accountable care organizations to patient-centered medical homes to electronic health records to data privacy, etc.
Proponents of getting rid of Net Neutrality:
Those who want to get rid of net neutrality make the argument that net neutrality is an unwarranted restriction and that without net neutrality, competition will increase, business will flourish, and the “free market” will solve all the world’s problems.
They are wrong, net neutrality will decrease competition to those who can pay, only certain businesses (the big ones that already hold too much power) may flourish more, and the free market has never solved all the worlds problems and has in fact made many problems worse (particularly healthcare) (not to mention that this really does just the opposite of making a free market).
What’s happening to Net Neutrality right now:
Net neutrality rules were put into place in February 2015 with the stated purpose* that the rules were “designed to protect free expression and innovation on the Internet and promote investment in the nation’s broadband networks.” Specifically it imposed the following “Bright Line Rules”:
- No Blocking: broadband providers may not block access to legal content, applications, services, or non-harmful devices.
- No Throttling: broadband providers may not impair or degrade lawful Internet traffic on the basis of content, applications, services, or non-harmful device
- No Paid Prioritization: broadband providers may not favor some lawful Internet traffic over other lawful traffic in exchange for consideration of any kind—in other words, no “fast lanes.” This rule also bans ISPs from prioritizing content and services of their affiliates.
However, these rules are being rolled back. Just yesterday, the new chair of the FCC, Ajit Pai commented on the net neutrality rules stating, “This practice significantly raises the odds of policies that do more harm than good, actually producing net negative benefits” (cited here). Our current president himself signaled that we should do away with net neutrality.
And while this seems like an esoteric issue, it is not. This will have affects in healthcare. And it should not be just hospitals and startups that are worried about this, patients should be paying attention to this too. It’s been mostly flying under the radar for years now, and I think it will continue to unless patients start to realize how this will affect their ability to receive healthcare.
One more aspect in the bigger picture:
I think its easy to see each administrative action as separate. But it is important for us to see the bigger picture. As I mentioned above, new measures were signed into law that allow your private data to be sold by your internet service providers. This data can include your health data, or in the very least the sites that you visit to understand your health (say if you googled symptoms of an STD or if you were in your doctor visit and you googled something you were discussing).
Why does this have anything to do with net neutrality? On it’s face, nothing. But if you think about how data may be prioritized without net neutrality, such that if there are special provisions to have “clear, monitored exceptions … for specialized services such as dedicated, mission-critical networks serving a hospital” or to other aspects of healthcare, this may include screening the content of the data which would have implications for privacy of your data. In other words, your health data privacy will be compromised at many levels from laws that favor and give far too much control to internet service providers.
There is a lot going on in the world right now. It is incredibly hard to keep up with all the news and all the ways in which new laws and rules have and will affect our lives. Patients already have a lot to worry about so adding extra worry may seem like overload. But don’t tune out. While Supreme Court nominations are important and what is happening in Syria is important and whether we will lose the provisions of the Affordable Care Act is important, so too are these other measures. Their effects may not be splashy and may not seem to affect you right now in a meaningful way, but I am fairly certain they are already in ways that will become exponentially more apparent as healthcare increasingly interfaces with and is indivisible from the internet.
See the bigger picture here. This deserves our attention.
Here are a few in depth articles on net neutrality from a few years ago, and which I relied on for parts of this post:
*Note: the website I link to here is the FCC site as of April 6, 2017 at 12:27pm MST. As many government pages are constantly changed within this new administration, one that is against net neutrality, I suspect it might change. If it does change, the original post is saved on the WayBack Machine Internet Archive here: https://web.archive.org/web/20170406182636/https://www.fcc.gov/general/open-internet.