Net Neutrality is the principle that all Internet service providers should enable equal access to all content found on the web, regardless of its source. As the government considers whether to do away with net neutrality, it’s important to think about how the elimination of this principle might impact patients and healthcare, in areas including: telemedicine; remote monitoring; access to cloud-based EHRs; addressing health disparities; encouraging digitally-based healthcare innovation; and patient access to online health content such as articles and videos. Kimberley R. Barker

1. Net Neutrality:
how its elimination might
impact patients & healthcare
Kimberley R. Barker, MLIS
Librarian for Digital Life
Claude Moore Health Sciences Library
The University of Virginia

2. Overview
• What is the Open Internet?
• What is Net Neutrality?
• Background
• Why is it important?
• What does it mean specifically for healthcare?
• How would its elimination affect healthcare?

3. The Open Internet
“…the idea that the full resources of the Internet and
means to operate on it should be easily accessible to all
individuals, companies and organizations.
This often includes ideas such as net neutrality, open
standards, transparency, lack of Internet censorship, and
low barriers to entry.”

4. Net Neutrality (in other words)
•“The term net neutrality has come to encapsulate
the idea that Internet providers such as Comcast or
Verizon should treat all web traffic equally and fairly.
This means they can't block access to any websites
or apps, and can't meddle with loading speeds. The
2015 rules also included a ban on so-called paid
prioritization: the idea that Internet providers
shouldn't give special treatment to apps and
websites that pay extra.”

5. Background
•Communications Act of 1934
•Services divided into two groups: Title 1
(Information Services) & Title 2 (Common Carriers
 telephones; trains)
•Title 1 was considered non-essential;
Title 2 was considered essential  put under
federal oversight; regulated.

6. Background (2)
• Oct 2002- FCC treats cable Internet access and DSL
internet access differently; deregulates cable (Title 1)
• Jan 2003- Professor Tim Wu coins term “net neutrality”
• March 2005- FCC fines an ISP for preventing its subscribers
from using a VoIP service that competes with its own voice
calling offering.

7. Background (3)
• Oct 2007- then-Senator Obama expresses support for net
neutrality
• May 2010- the FCC votes for strong net neutrality
protections (ISPs cannot block or impose limits)
• Jan 2011- Verizon files a federal lawsuit against the FCC
• Jan 2014- Federal Appeals Court strikes down the FCC’s
2010 vote

8. Background (4)
• Jan 2014- A user-created petition on “We The People” called
for the Obama administration to restore net neutrality
protections
• Sept 2014- FCC opens a public comment period on internet
regulatory structure (15 million Americans commented; more
than ever had before- on any issue)
• Nov 2015- then-President Obama called for strong laws to
protect net neutrality

9. Background (5)
• 2015 – The Open Internet Order; the FCC reclassifies broadband as
Title 2
• focuses on three specific rules for internet service: no blocking, no
throttling, and no paid prioritization
• Feb 2016- the FCC votes to enforce strong net neutrality laws
• June 2016-federal court of appeals fully upholds the FCC’s strong
net neutrality rule
• May 2017- the FCC, under new leadership, votes to begin the
process of rolling back net neutrality protections
• Sept 2017- Net Neutrality proponents rally

10. One Possible Future

11. Healthcare areas at risk
• Telemedicine deployment
• Use of wellness apps
• Sharing of healthcare data
• Remote monitoring

12. Healthcare areas at risk
•Connected sensors/devices
•EHRs (high-speed connectivity crucial)
•Public health outreach (barber shops; churches)
•Patient education (videos, etc)

13. Populations at risk
•Poor
• Relegated to the “slow lane” of the Internet because
they can’t pay for the “fast lane”
•Rural
• Current lack of infrastructure means rural people will be
at further disadvantage for accessing content

14. What’s next?
•As of 8/3/2017, the FCC was finally fully staffed with
five members.
•Ajit Pai (who opposes net neutrality) is the FCC
Chairman; he must be reconfirmed or step down by
the end of 2017.

15. Resources
• “What is Net Neutrality?”
• http://whatisnetneutrality.org/timeline
• Net Neutrality
• http://observer.com/2014/12/net-neutrality-explained-in-one-image/
• 7 Possible Consequences Of Losing Net Neutrality
• https://www.psfk.com/2014/01/7-consequences-net-neutrality.html
• “What would the end of net neutrality mean for healthcare?”
• http://www.healthcareitnews.com/news/what-would-end-net-neutrality-mean-
healthcare

16. Resources
• “AMIA presses FCC on broadband access as a health issue”
• http://www.healthcareitnews.com/node/538320
• “Net Neutrality Debate and Connected Health”
• http://www.cchpca.org/sites/default/files/resources/Net%20Neutrality%20D
ebate%20and%20Connected%20Health%20FINAL_0.pdf
• “The End of Net Neutrality Could Shackle the Internet of Things”
• https://www.wired.com/2017/06/end-net-neutrality-shackle-
internet-things/

17. Resources
• “FCC's net neutrality reversal threatens telehealth, remote
monitoring and data sharing”
• http://www.fiercehealthcare.com/regulatory/net-neutrality-reversal-
threatens-telehealth-remote-monitoring-and-data-sharing
• “What happens to telemedicine if we lose net neutrality?”
• http://www.healthcaredive.com/news/what-happens-to-telemedicine-if-
we-lose-net-neutrality/443908/
• “Family physicians to FCC: Net neutrality is 'paramount' for US
healthcare”
• http://www.beckershospitalreview.com/healthcare-information-
technology/family-physicians-to-fcc-net-neutrality-is-paramount-for-us-
healthcare.html

18. Resources
• “Rolling back net neutrality would hurt minorities and low-
income families”
• http://thehill.com/blogs/pundits-blog/healthcare/333581-
rolling-back-net-neutrality-would-hurt-minorities-and-
low
• FCC back to full five members as net neutrality vote looms
– 8/3/2017
• http://www.politico.com/story/2017/08/03/fcc-nominees-
confirmed-jessica-rosenworcel-brendan-carr-241298