Promoting Competition to Achieve Our Health IT and Health Care Goals
Jodi G. Daniel, J.D., M.P.H. and Karson Mahler, J.D. | October 7, 2014
ONC has long recognized the need to foster innovation and competition to achieve the nation’s health IT and health care goals. The HITECH Act charged us with enabling the electronic use and exchange of health information—information that will support consumers and facilitate better quality and more efficient care.
A competitive and dynamic health IT marketplace fundamentally supports that mission by encouraging and rewarding innovation that drives improvements in the technologies and services providers and consumers need to strengthen our health care system.
ONC and the Federal Trade Commission (FTC) have begun collaborating in new areas to advance our shared commitment to promoting competition in health IT markets while ensuring that health IT is a driver of quality and value in health care.
In March of this year the FTC convened a two-day public workshop, Examining Health Care Competition. Not only did we participate in a panel discussion, but the workshop also included a session on health IT opened by comments from Karen DeSalvo, the national coordinator for health IT.
At the workshop, we heard plenty of reasons to be encouraged about ways that competition is working to deliver interoperable systems and services. As one presenter put it, since 2009 the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs have inspired the most rapid growth in information technology adoption in any industrial sector in recent history. And with new payment and delivery reforms under the Affordable Care Act, demand for health IT products will continue to grow as providers migrate toward new business models that depend on health IT and health information exchange (HIE) for quality measurement, analytics, population health management, and risk-based contracting.
Despite successes, however, a clear takeaway from the FTC workshop was that health IT markets are not functioning as efficiently as they could be. Commonly cited concerns included:
- A lack of transparency and comparability for health IT products and services, including accurate and complete information about costs and limitations. Without this information, health IT purchasers may find it difficult to exercise informed choice in the marketplace, despite the availability of competing products and services.
- A lack of interoperability across health IT products and services, which panelists and commenters explained may limit the potential of health IT and HIE to support improvements in health and care delivery. Because of the lack of mature and widely adopted industry standards for interoperability, a good deal of innovation to date has occurred within what some panelists termed “walled gardens”—closed information sharing networks often based on expensive and proprietary health IT solutions adapted to the needs of existing health care delivery systems. As market-based reforms shift provider incentives towards new care delivery models that reward quality and value, there is a risk that some providers may find themselves “locked in” to rigid technologies or information sharing networks. As a result, these providers may find it prohibitively expensive to switch to new technologies that offer superior value, capabilities, and opportunities for delivering higher quality and more efficient care.
- Business practices that inhibit or block the electronic sharing or transfer of health information. We also heard concerns regarding developers or providers who restrict information exchange with users of other EHR products or HIE services. Such conduct could include policies or practices that prevent or make it difficult to establish connections (or “interfaces”) to other systems. It could also include price or other contractual terms that limit “data portability” in the event that a provider decides to switch to a different health IT vendor’s product.
ONC and FTC intend to work more closely in the coming months to understand these and other competitive issues involving health IT—issues that may limit the ability to realize the goals for interoperability and improved patient care. The FTC’s companion blog post reflects our common commitment to competition as a driver of quality and value in health care, with health IT a vital part of competitive markets.
ONC and FTC are cooperating and sharing information to better understand market dynamics related to health IT. In consultation with FTC, ONC will formulate policies that advance patient care through competition and innovation. Government policy may be able to improve transparency, promote interoperability, create incentives for quality, and reduce barriers to competition and innovation.
For example, to promote more transparent health IT markets—and consistent with HHS’s larger commitment to health care transparency—ONC publishes certification test results and requires health IT developers to disclose certain costs associated with certified health IT products. We also work with industry and other stakeholders to advance core technical standards and functions that reduce the costs of entry and open up opportunities for innovators and new technologies.
We expect to continue to build on and expand these efforts going forward as we encourage greater market transparency by the private sector.
ONC will continue to actively monitor health IT-related business practices that could impede progress towards interoperability or harm competition or consumers. We will also share information and our industry awareness with FTC and assist the Commission to monitor and investigate questionable practices.
As we develop the draft nationwide interoperability roadmap, we know a competitive and dynamic health IT marketplace is essential to achieving the vision. Wherever possible, we will use our authorities and coordinate with other agencies to promote transparency in health IT markets, empower purchasers to make better decisions, and eliminate barriers to competition and innovation.
ONC looks forward to engaging with the health IT community on these issues. We encourage you to contact us and to share your perspectives.
For more information about FTC’s interest in health IT competition issues and collaboration with ONC, read the FTC’s companion blog post.