A debate is raging over “net neutrality” which likely will affect telemedicine. (Brookings column) The concept of net neutrality is that all users of internet infrastructure should pay the same, regardless of the intensity of their use and that no packets of information should be given preference in transmission. The concerns with this approach are that if infrastructure providers can’t charge according to intensity, they may not be able to generate sufficient revenue to justify construction of sufficient bandwith. There is also a fairness concern–why shouldn’t more intense users pay more, especially if they are willing to do so to ensure rapid and accurate information transmission.
Many health care uses are very data intense, both because of content and the necessary privacy techniques. Medical imaging is a classic example. Health care often also needs to be assured of very rapid, almost instantaneous transmission. Net neutrality may undermine the growth in telemedicine and ehealth. Our policymakers should consider these concerns before making decisions that might hinder their health care goals of better access and quality and lower costs.
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at 
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