Saturday, March 13, 2010

How A Changing Internet Could Change Healthcare

Big things are happening to the Internet, and that means big potential changes to healthcare. This is, after all, the Information Age, so anything that happens to information happens to our health. The challenge will be to simultaneously improve our health while protecting our privacy and dignity.

The official plan from the Federal Communications Commission is to be released on Tuesday, although FCC Chairman Julius Genachowski teases it in Sunday's Washington Post.

In the meantime, Grant Gross, writing for PC World, reports that some hints are already available. In a speech last month, Genachowski said that the FCC's goal is "to bring 100M bps (bits per second) broadband service to 100 million U.S. homes by about 2020."

Nationwide, that's would spell a huge increase, more than a hundred times faster than current DSL plans, for example. Such ubiquitously accelerated speed will change everything about the Internet, of course, but here at SMS, we were struck by a little throwaway in The New York Times report on the broadband plan that wasn't so little:

The plan envisions a fully Web-connected world with split-second access to health care information and online classrooms, delivered through wireless devices yet to be dreamed up in Silicon Valley.

Note the inclusion of "health care information." Indeed, that could be the future of healthcare, to see everything integrated into one vast interactive tool, one vast record keeping mechanism. Imagine: Being able to get a diagnosis online, via fullmotion interactive video, anywhere in the world. And perhaps it will be automated some day--a computer could provide at least the first "consultation." And who knows what might be possible after that. Imagine all your health records following you around, in the cloud. Imagine the whole of humanity uploading data into that same cloud, so that doctors and scientists can better identify public-health patterns and take constructive action. An Internet-as-Mednet could save, and extend, a lot of lives.

So that's a goal worth working for, if. If, that is, the problems can be worked out. As PCW's Gross puts it, the FCC's plan is no slam dunk:

The broadband plan could meet resistance from incumbent providers as soon as it sees the light of day, said Craig Settles, a community broadband consultant and president of

"I believe the plan is too ambitious for many inside Washington to fully embrace in terms of executing legislation and making funds available," he said. "The average lawmaker, particularly with elections coming up this year, could not care less about broadband. These are the ones most susceptible to lobbyists' attempts to neuter the plan. The telecom and cable industry will mine the lofty rhetoric while trying to kill anything they feel threatens profits."

And the pipeline companies have a point: They paid for this infrastructure, and so they should have a say in how it is used. A say, which is not the same as veto.

And there will be other problems ahead. As one of the commenters in the PCW story, "ebystrom," put it:

This will result in government takeover of the industry. It won't happen overnight, but incrementally. They already have the name for it: National Broadband, like National Health Care.

Not everyone worries about national health insurance--some are all for it. But as the polls show, most people are a little bit nervous at the thought of too much power being centralized in Washington--whether it's broadband or healthcare.

The great challenge, of course, is that abundant medical information, online, is a double-edged sword. Medical digitalization is great if you control the data, not so great if others can snoop or hack into it. Digitalization is great if doctors and hospitals have online files that can be moved around, wherever they are needed, at the push of a button, but it's not so great if the trial lawyers, too, can push a button and get the same information. Digitalization is great if it helps your doctor treat you, not so great if a cost-conscious government puts a bureaucrat between you and your doctor. So controversies over security and privacy and transparency are going to be profound questions in the years to come.

And a past FCC Chairman, Reed Hundt, provided a fascinating peek into the FCC's past policies in a recent speech at Columbia University, as reported by Harry Jessell of TVNewscheck:

Hundt said that his decision to favor broadband over broadcast was made in 1994, when his first days as FCC chairman coincided with the introduction of the Mosaic browser and the emergence of the Internet as a commercial medium.

"We decided ... that the Internet ought to be the common medium in the United States and that broadcast should not be," he says. The "we" includes Blair Levin — who is the principal author of the National Broadband Plan and who was Hundt's chief of staff — as well as Genachowski, who was a top aide and thinker.

Hundt said the decision was made even though TV broadcasting had ably served the country as the common medium since the year he was born, 1948.

And then he gave several reasons why.

The Internet was "going to be the pathway for the global promulgation of American values and American technology, he said. "A nation that doesn't believe ... that its values are values that ought to be shared and sold, if you will, to other countries, that's not the United States.

"Second, [the Internet] was fundamentally a richer medium — text and pictures — and that therefore it was going to be an easier and better way for people to have access to information. ..."

He also believed the Internet was "certain to be diverse in every conceivable respect and not by dint of regulation — diverse, meaning it would be in every language and every race would be welcome and the content would be ... generated by people who ... would choose any points of view; and any kind of ownership of the content would be admissible and any form of the content would be possible."

The whole article is extremely interesting, because Hundt is staking his claim to the historical record as a major mover and shaker on the Net. Indeed, as Hundt says, the FCC "stole the value of the telephone network and gave it to . . . society." Legally, of course--any more questions? And Hundt says, at the same time:

The FCC tried to suppress broadcasting. "This is a little naughty: We delayed the transition to HDTV and fought a big battle against the whole idea."

In other words, according to Hundt, he and his colleagues deserve credit for hurting the phone companies, and the broadcasters, and helping the Internet suppliers. This is Hamiltonianism of a high order, or, if one prefers, industrial policy.

Historians will kick these claims and counterclaims* around for a long time to come, but in the meantime, myriad issues of the present Net are unresolved--and perhaps becoming more unresolvable.

It seems, for example, that the Net is becoming ever more like "The Truman Show"--everybody is watching everybody. How happy are we to read, for example, "Twitter is watching you... New technology tells the world where you're tweeting from"? Might that be just a tad disconcerting? Tweeters have the power to opt in or opt out, of course, but do people really trust such promises? And it's probably the same with other services, such as Foursquare and Loopt and all the rest. Let's face it: If these companies are giving customers their services for free, they must expect something in return.

Indeed, the same sort of data-trend is apparent in other areas of our lives. How will we feel about knowing that every new car has a "black box" that tracks our vehicle activity? As Reuters puts it:

National Highway Traffic Safety Administration chief David Strickland told a congressional hearing on Thursday that the regulator is considering whether to make "black boxes" mandatory for all new vehicles. The devices can capture data on speed, braking effort and other details which can be vital in reconstructing accidents.

Scientists are even starting to figure out how to read our minds:

In a recent study, published in the March 11 online edition of Current Biology, British scientists from University College London found that they could identify human thought patterns in the brain by using functional magnetic resonance imaging (fMRI).

It's possible, of course to read too many articles and get too worked up over privacy. And in fact, a contrarian view comes from well-known tech journalist Declan McCullagh, who wrote a piece on Friday entitled, "Why no one cares about privacy anymore."

But plenty of people do care about privacy. And so the FCC plan is going to face a rocky road, even as most people agree that it would be pretty cool if we all had greater access to a faster and ever more useful Net.

So some of the grand battles of the 21st century are being outlined now: Between the old and the new, between tradition and innovation, between privacy and transparency. And that's just in the US. The rest of the world will have its own fights.

*The historical battle for Net credit is by no means as open-and-shut as Hundt claims. Back in 2000, Hundt published a book, You Say You Want a Revolution: A Story of Information Age Politics, in which he argued, “Al Gore did not invent the Internet, but he did invent the political economy of the Internet.” There was a claim perfectly timed for the 2000 presidential election. But in a Newsday column dated June 13, 2000, I took exception to the pro-Gore claim:

In a brief aside on page 133 of his book, Hundt notes a “far-sighted, or accidentally smart” ruling by the Reagan-era FCC that prohibited phone companies from levying “access charges” on data (as distinct from voice) transmissions. “In the absence of the FCC’s decision,” Hundt writes, “the Internet would have been so expensive that [founder Marc] Andreesen’s Netscape would not have been a hiccup, much less one of the first bubble stocks of the Internet.”

Whoa. After all this pro-Gore buildup, Hundt concedes that the biggest pro-Internet policy dates back to the early 80s - - when then-Congressman Gore was denouncing the evils of Reaganism. Could it be that Hundt’s intellectual honesty has, in this instance at least, gotten the best of his partisan fealty?

David Colton, counsel for the Information Technology Association of America, has the old case at his fingertips: MTS and WATS Market Structure, Order, 97 FCC 2d 682 (1983). That order wasn’t an accident, Colton said in an interview: “It was a principled free-market decision...that in the years that followed gave birth to AOL, to Compuserve, to every ISP [Internet Service Provider] that’s ever come into existence.” And to that honor roll of wealth- and job-creation, one must add such Internet-oriented manufacturers as Cisco Systems - - founded in 1986, seven years before Clinton and Gore took office.

Colton freely credits Hundt with continuing the pro-competitive momentum at the FCC, but of course, that’s not the same as starting it. Hundt’s entertaining book reveals much about how Washington works, but it reveals more about how history can be sculpted to serve a present-day partisan agenda.


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