At last week's Federal Trade Commission workshop on healthcare competition held in Washington, industry stakeholders warned that the proliferation of closed data networks are trapping providers and patients into proprietary networks that are barriers to interoperability and competition. Specifically, they charged that some health systems block patient information sharing in ways that have antitrust implications.

"When the government comes with a check and subsidizes the purchase of a system that deliberately does not interoperate, does not communicate with other vendors, the government is effectively perpetuating and supporting that phenomenon," said Dan Haley, athenahealth's vice president of government and regulatory affairs. "When the government comes and says we will issue blanket antitrust scrutiny waivers for entities that create ACOs and we will put on the blinders as those entities purchase and implement closed system technologies in an effort to make their networks 'sticky' and consolidate market share, government is perpetuating this problem."

The purpose of the two-day FTC workshop was to study market activities and trends that affect competition in the evolving healthcare industry. Jodi Daniel, director of the Office of Policy and Planning in the Office of the National Coordinator for Health Information Technology, said that from ONC's perspective the goals of market competition and health IT are mutually reinforcing. Interoperable health IT infrastructure can enhance competition by allowing data to flow more freely in the healthcare market, said Daniel. "It can help competition in the healthcare market," which is central to ONC's health IT goals.

She said that ONC is focused on the challenge of ensuring that "information follows the patient" by emphasizing interoperability and exchange of health information. "We're both looking at how we can promote innovation and competition to support the exchange of electronic health information, so things like standards and certification, making sure there's trust and confidence through privacy, security and safety, as well as things like exploring how open standards and architectures can lower entrance and looking for governance in health information exchange.”

Daniel told the audience that ONC is also looking into "some market failures that may inhibit the free flow of electronic health information" such as pricing structures. "We've heard some folks, some stakeholders giving us some feedback about some pricing for health information exchange that may be limiting the free flow of information," she said, adding that ONC is also interested in "any kind of practices that may lead to lock-in of information or siloing of that information, as well as transparency with respect to the products, the usability of the products, the services, etc."  

However, athenahealth's Haley argued that there are many legacy software vendors whose business models are deliberately built around creating closed systems. "If the overriding policy goal is health information exchange and information fluidity nationally, then the government shouldn't be subsidizing those systems," he said. "And, if the goal is sharing information across networks and between networks, then the government shouldn't be turning a blind eye for years to deliberate data lock and market consolidation that comes from it."

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