Network neutrality key to health information exchange

Network neutrality is central to planning for health information exchange, and potential regulation has implications for healthcare providers that use or provide services, according to research published at the Journal of the American Medical Informatics Association.

The paper discusses the need to establish the concept of "common carriage," similar to that of a utility that serves the public good as the Nationwide Health Information Network (NWHIN) is established. Last fall, however, the Office of the National Coordinator for Health IT turned that effort over to the public-private partnership Healtheway, which just named nine founding organizations in its efforts to move forward.

According to the authors, HIE must be "non-discriminatory in content, ownership, source address and destination address" to be truly "neutral and open."

"This means that if an ISP, such as Comcast, partners with Onpatient or Dossia, it would not be permitted to give preferential network layer treatment to a PHR from Onpatient or Dossia services over, for example, Microsoft's competing HealthVault service," they added.

However, the authors said, that happened when Verizon partnered with a wireless home-monitoring solution called Oncare, developed by Zora, giving it a better quality of service than other home-monitoring competitors.

Companies such as AT&T, Verizon and Cisco oppose neutrality regulations, arguing that the owners of the pipeline should be able to manage traffic in the most efficient way--and to charge access fees for use of that pipeline. Companies that provide or use online content, including most healthcare organizations, tend to be proponents of network neutrality.

The benefits of telemedicine, the authors said, might not be achieved without a neutral network. They continued that network neutrality meshes well with HIPAA privacy regulations, since standards such as those used in transmission of credit card data already exist.

"The nature of network neutrality promotes security and privacy because of its emphasis on transparency in data content, source, ownership, and destination and reliance on end-to-end security associations," they said.

Dealing with myriad state privacy laws, however, has been a thorny issue. The HIT Policy Committee asked the Privacy and Security Tiger Team to offer more recommendations on non-targeted queries.

Meanwhile, the California Office of Health Information Integrity has been working on a framework to help HIEs scale in a way that doesn't require them to draft separate data-sharing agreements with each partner.

To learn more:
- read the JAMIA article