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Readers Write: America’s Doctors Need a Neutral Internet

June 1, 2017 Guest articles No Comments

America’s Doctors Need a Neutral Internet
By Matthew Douglass


In 1984, Stewart Brand, a close friend of the founders of the Internet, famously said, “Information wants to be free. Information also wants to be expensive.” Three years ago, I detailed why classifying the Internet under Title II of the Communications Act was so important to preventing Internet services and accompanying information from becoming expensive for Internet consumers and businesses. An active public debate occurred that year, with a record 3,700,000 public comments submitted to the FCC, including the views of hundreds of top investors, leading technology companies, churches, and civil society groups.

After much public debate and consideration, the FCC in 2015 voted to regulate broadband Internet service as a public utility in an effort to “protect innovators and consumers” and reassert the Internet’s “core of free expression and democratic principles.” Cable and telecommunications companies are now explicitly restricted from discriminating among website providers and content, or treating them in a different manner. Today, the Internet thrives as it has since its invention: There are no fast lanes or slow lanes, and no company’s Web traffic can receive preferential treatment or prioritization.

Just two years after that rulemaking by the FCC, Ajit Pai, the new head of the FCC, has now proposed repealing that critical decision. Changing these existing rules could allow Internet service providers to charge different prices to consumers and businesses based on the influence of the company transmitting data or the type of information being transmitted.

As was successfully argued a few years ago, differently priced lanes on the Internet would primarily benefit incumbent Internet applications and be particularly burdensome for Internet consumers and small businesses fighting to compete with larger, entrenched companies.

The Health IT Connection

Medical practices in the US are becoming increasingly reliant on EHRs to run their businesses and treat patients. The future of EHRs is in the cloud, especially for independent physicians who are particularly sensitive to technology costs for their lean, small businesses. The last thing that independent physicians need is to have to bear additional costs to their business on top of what they already spend on critical medical technology.

Imagine if there were more expensive lanes on the Internet that promised faster speeds. By definition, the less expensive lanes would be slower. Since healthcare applications are now mission-critical for doctors to be able to treat their patients, customers of ISPs that introduce tiered pricing would be forced to choose the faster, more expensive plans. Physicians operating their practices on a shoestring budget would be directly affected and would potentially face significant harm. At a time when the entire healthcare industry is shifting to value-based care, we should be looking at ways to ensure the financial viability of independent practices, rather than endangering their existence by imposing additional, unnecessary costs.

Another ramification of allowing ISPs to determine which traffic belongs in a fast lane is that they could preferentially speed up or slow down the services of specific companies. For instance, a digital health company owned by an ISP could be given preferential speed over the services of competitors. This situation would directly impede competition, discourage startup companies from entering the space, and reduce freedom of choice for physicians and patients. America’s doctors and patients should determine which Internet-enabled healthcare services will thrive based on better functionality, not because of delivery speeds decided by ISPs with potential conflicts of interest.

If it Ain’t Broke, Don’t Increase the Cost

The Internet Association and its member companies, including mine, has reasserted its support of the existing FCC regulation of the Internet: “The [I]nternet industry is uniform in its belief that net neutrality preserves the consumer experience, competition, and innovation online. In other words, existing net neutrality rules should be enforced and kept intact.”

Doctors need new, innovative technologies and freedom from the burden of new, unnecessary costs to be able to do their jobs well in our rapidly evolving, 21st century information economy. The last thing they need is the heavier burden of additional costs required to run technology that is essential for patient care. A neutral Internet without fast or slow lanes is crucial for the US to maintain the innovative and entrepreneurial engine that has driven our powerful information-driven economy for decades.

When medical students begin studying for careers as physicians, they pledge to “first, do no harm.” The FCC would be wise to take a similar approach to net neutrality as it stands today: “If it ain’t broke, don’t fix it.”

Matthew Douglass is co-founder and SVP of customer experience at Practice Fusion in San Francisco.


Jenn, Mr. H, Lorre

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