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The FCC's net neutrality repeal vote could hurt video telemedicine providers and consumers and restrict the ability of less affluent healthcare providers to exchange data-intensive medical images, health IT advocates said.
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The Federal Communications Commission's 3-2 vote along partisan lines also widened another ideological fissure between ruling Republicans and congressional Democrats and had tech giants, such as Amazon, criticizing the net neutrality repeal as dangerous deregulation that would drive up consumer costs for internet bandwidth.
"It absolutely impacts telemedicine, and this dials back the whole forward momentum of digital health and innovation," telehealth expert and advocate Nick Adkins, an advisory board member of telemedicine vendor Cloudbreak, told SearchHealthIT.
Repeal backers see free internet market
Supporters of repealing the two-year-old, Obama-era rules that treated internet service providers (ISPs) as public utilities that could not set different prices for different customers say repeal opens the internet service market to competition and more consumer choice.
Nick AdkinsTelehealth expert
"We have a free and open internet going forward," FCC Chairman Ajit Pai said on a Fox TV show on Dec. 15, the day after the vote. "The FCC and the FTC [Federal Trade Commission] going forward are going to make sure that happens."
Under the net neutrality repeal, the FTC will share with the FCC enforcement of transparency rules that are part of the repeal – formally, the Restoring Internet Freedom Order. The FCC will look into complaints about ISPs slowing down or blocking legal internet traffic, and the FTC will investigate whether ISPs have engaged in illegal, unfair or deceitful business practices.
Slower internet for smaller users
Adkins argued that big ISPs (such as Comcast, AT&T and Verizon) could throttle bandwidth speeds for smaller customers under a deregulated system in which ISPs could provide "fast lanes" on the internet for big, cash-rich customers and slow processing for lesser customers.
According to net neutrality repeal critics, smaller, less well-heeled healthcare systems and providers could see delays or even an inability to send and receive MRI and CT scan results, and health researchers working in remote locations could experience slow or nonexistent internet connections.
"Especially with bidirectional video, you're talking a significant amount of bandwidth," Adkins said. "Large healthcare systems would be at an advantage. But if you're a rural system or small practice or provider, you're at a disadvantage."
Another net neutrality repeal critic, Boston lawyer and health IT blogger David Harlow, said in an interview that, under net neutrality, there was a provision to allow ISPs to prioritize medical data traffic; that is gone now.
Questions about FTC enforcement
Harlow also questioned the enforcement and consumer protection capabilities of the FTC in the internet arena.
"It's ad hoc, complaint-driven enforcement, which is really not the way to do this," he said.
Harlow said he was most worried about how the FCC's move could affect clinical applications requiring internet bandwidth.
He described a scenario under net neutrality repeal in which rural providers' potential inability to quickly receive medical images could hurt ordinary medical consumers.
"If I'm in the emergency room in Montana and my treatment depends on accessing an MRI of my head taken in Boston when I was relatively healthy, then I want that image to be zapped to Montana instantaneously," he said.
Harlow also noted that less data-hungry health IT applications, such as care coordination platforms, might be affected if ISPs charge vendors higher prices. Those vendors would then presumably pass the added costs onto the healthcare system, which would drive up healthcare costs for patients and profits for ISPs.
Potential millennial political issue
Politically, Adkins said, the net neutrality repeal could be a galvanizing issue for millennial smartphone and Amazon Echo users who may not be affected much by healthcare issues, yet could suddenly find themselves hit with sharply higher monthly internet fees.
"They're relatively healthy. They're on mom and dad's insurance plans. They're relatively insulated from this whole healthcare discussion," he said. "Now, you're going to talk about what's really important to me: my internet connection."