Fostering Healthy Competition – The Competition Bureau’s Digital Health Care Market Study

The COVID-19 pandemic has rekindled interest in modernizing Canada’s health care system. For its part, the Competition Bureau (“Bureau”), has conducted a digital health care market study examining how pro-competitive policies can foster innovation and bring more choice and access to digital health care services for Canadians. After consultation with multiple stakeholders, the bureau published its first report on the competitive role of personal health information in June 2022, followed by a second report on improving health care through pro-competitive procurement policy in October 2022. A third and final report is expected in the coming months. The Bureau’s papers highlight some of the key regulatory, technical and procedural aspects of the current Canadian health care system that may hinder competition, and provide a number of recommendations that, while having the potential to significantly impact the highly competitive landscape Huh.

Part 1 – Unlocking the power of health data

While Canadian health care systems are data rich, health care providers have struggled to convert this data into information that can be used to drive innovation and improve patient care. first report, Unlocking the power of health data, proposes steps for Canadian policy makers to improve access and sharing of personal health information with the aim of promoting competition and innovation in the health care industry. Looking specifically at primary health care electronic medical record (EMR) systems (i.e., the systems used to collect personal health information in family doctor offices, hospitals, and other primary health care settings), reports for competition Identifies two major barriers:

  1. Different privacy and data governance rules across provinces and territories create structural inefficiencies, resulting in market fragmentation and high entry costs for new entrants. As a result, only a handful of primary health care EMR companies currently compete in most provinces and territories, while PEI, Newfoundland and Labrador, the Northwest Territories and Nunavut are limited to a single primary health care EMR provider.
  2. With no standard for data storage in primary health care EMRs, information is locked into the specific EMR system chosen by the primary health care provider, making it difficult to switch between EMRs or to visit other health care providers using a different EMR. Sharing patient information with In addition, primary health care EMR companies are acquiring other players in the health care sector (virtual care providers, community clinics, etc.), which expands opportunities for vertical interoperability, but may also stifle innovation where these companies Limit the capabilities of other third party solutions. Interface with their EMR.

To achieve interoperability between primary health care EMRs and EMR systems in other health care settings (e.g., pharmacies), the Bureau recommends:

  1. Consistent privacy and data governance rules across Canada – Looking to peer jurisdictions, the Bureau recommends the use of legislative instruments (for example, 21scheduled tribe the CenturyCure Act in the United States) and digital solutions to develop a national health data plan (eg, “My Health Record”, a similar national electronic records system in Australia). A national health data plan would ease market entry and expansion for domestic and international companies, foster greater competition and innovation across the country.
  2. adversary’s compliance is required,blocking rule Anti-blocking rules are those that would prevent health care EMR companies from interfering with the access, exchange and use of electronic personal health information. Recommended features for an approach in Canada include encouraging compliance, establishing a common standard for data storage and transfer, and keeping the cost of data sharing reasonable.
  3. establish interoperability standards The bureau recommended that these standards should be established, implemented and operated by an independent organization, aligned with international standards and allow flexibility to develop follow-on innovations.

Part 2 – Improving Health Care Through Competitive Procurement Policy

Since public entities are the main purchasers of health care products and services in Canada, public procurement rules play an important role in determining who can compete for government contracts and, in turn, competition and demand in Canada’s digital health care sector. -Promotes innovation. The bureau’s second report focuses on how the strategic use of government procurement rules can bring more competition, innovation and choice to health care providers and patients. In particular, the report emphasizes the role that small and medium enterprises (“SME”) play a role in driving innovation and the need for a public procurement process that facilitates opportunities for these companies. Through its consultations, the Bureau identified six barriers to competition in the public procurement process:

  1. Health care falls under provincial and territorial jurisdiction, while the federal government, under canada health act, defines national principles reflected in provincial and territorial health care plans. This creates a fragmented procurement structure of 14 different jurisdictions, each with different priorities, statutes, regulatory authority, and levels of centralization.
  2. RFP requirements that are overly strict or inappropriately scoped may eliminate potential bidders, especially SMEs, who may bring forward innovative solutions.
  3. A focus on value, quality or results over price can hinder innovators and SMEs who often cannot match the low prices offered by larger companies.
  4. Risk aversion can result in favoring established or known systems and vendors over new or innovative solutions.
  5. The public procurement cycle can be outpaced by the rate of innovation, meaning that products and services may be out of date by the time the procurement process is completed. Lengthy procurement processes can also delay the innovator’s return on investment, which may affect further product development.
  6. Highly prescriptive policies (for example, requiring the use of a specific product or vendor) can drive potential innovators out of the market and perpetuate pro-competitive effects.

To address these barriers and promote competition and innovation through procurement policies, the Bureau recommends:

  1. Establish a national innovation procurement center for expertise to create a Canadian roadmap for the implementation of innovative procurement.
  2. Public procurers are self-evaluating their practices and removing any barriers in favor of competition, such as paying attention to the full life cycle of a product or service, how changes in technology will affect current and future needs. and affect any switching requirements between vendors.
  3. (1) supporting innovation-friendly procurement processes including the use of functional rather than technical requirements to allow vendors to compete on ways to achieve desired results, (2) eliminating red tape to effectively facilitate SME participation reducing, and (3) the flexibility to use award criteria that consider both quality and price.

next steps

The third and final report is expected to be published in the coming months to complete the Digital Healthcare Market Study. The final report will likely include some general topics that emerged from the Bureau’s stakeholder consultations that were not fully addressed in the first two reports, including compensation for health care providers, the expansion of digital health care products, and Contains policies that limit distribution. and services, increasing access, affordability and literacy about digital solutions, and patient safety.

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