Telemedicine could transform the medical experience we are accustomed to today. While it holds great promise, the FCC’s recent Open Internet rules threaten to bring this healthcare revolution to a stuttering halt.
The prospects of telemedicine are grand. Physicians and specialists will be a video-chat away. Equipped with smartphone enabled sensors, people could diagnose their own symptoms. Additional analyses can be performed by uploading the data to more advanced systems. One could even picture a two-way data stream where an autonomous agent could intelligently chose each next medical step, if not treatment, based on the results of prior tests.
Practices such as those above require prioritization, in one form or another, for timely data and optimal real-time performance. Delaying or dropping telemedicine packets – whose contents contain important health information for the sole sake of “packet equality” is a misguided choice detrimental to patient health.
Prioritization is also needed to enabled intelligent patient-doctor communication. Consider a teleconference between a psychiatrist and a patient with a history of schizophrenia. The psychiatrist needs to have an extended conversation with the patient, to listen and observe for any abnormalities which would indicate the patient is experiencing psychosis. If so, that conversation becomes an emergency situation. The doctor may try to keep the conversation going and attempt to calm the patient while awaiting a local medical response. Imagine that interaction then being interrupted, losing audio or video, or having a screen freeze, only so that someone else’s everyday web traffic is treated equally on the network.
What the FCC’s Open Internet rules do not acknowledge is that different services absolutely have different demands of the network. While we may agree to equal treatment of data in principle, enacting wholesale bans on prioritization and resource-reservation network technology is a bad idea. It denies the multiple service requirements a network was designed to accommodate and discriminates against emerging services that need prioritization in order to work. Ruining the quality of experience of one service type for the sake of equality with a differing service type (with dissimilar network demands) is not a true solution.
Further, the unfounded mistrust of differentiated services, compounded with a superficial view of the actual (and possible future) physical structure of the Internet, is evident not just in the prioritization and blocking bans. Under the FCC’s Title II regime, Customer Proprietary Network Information (CPNI) rules could be detrimental to the development of the infrastructure needed to support telemedicine. Broadband providers—and likely edge providers–would be deterred from applying any third-party network diagnostics to the customer endpoint, as this would be disclosing CPNI. This rule thus blocks the use of certain future multiple-service-provider adaptive-routing technologies. There are several emerging technologies (including cloud routing and predictive capacity allocation) that could ensure the timely, reliable, and quality experience required by telemedicine applications, but most of them will require disclosing some form of CPNI.
The future of the connected patient should not be held captive by outdated network classifications and regulatory sleight of hand. Connected services require both transmission and information processing that defy Title I and Title II silos. The FCC’s erecting legal ghettos and segregating services in arbitrary buckets undermines the very notion of information technology and does not serve to advance the innovations that can improve human health. The Internet is a platform of diversified and integrated services with disparate needs and a yet-unknown future. Perhaps a unified and all-encompassing classification cognizant of the diverse, dynamic, and differentiated needs of services is preferable.
Telemedicine has been a long-awaited move towards customer-centered healthcare that has reached a boiling point. The recent Open Internet rules effectively turn off the heat, dictating that the coming feast be prepared in a tepid pool of inaction, all in the name of equality. The FCC should not be a gatekeeper to the future of telemedicine. We need Congress to act, not only to clarify the role of the FCC, but to provide a much-needed modernized legal framework for Internet innovation.