Promoting Healthy Competition – Competition Bureau’s Digital Health Care Market Study

The COVID-19 pandemic has renewed interest in modernizing Canada’s healthcare system. For that part, the Competition Bureau (“bureau) conducted a digital health care market study to examine how pro-competition policies foster innovation and provide Canadians with more choice and access to digital health care services. After consultation with the Department, in June 2022, the Department will publish its first report on the competitive role of personal health information, followed in October 2022 by 2 on Improving Health Care Through Procompetitive Procurement Policies. published the second report. A third and final report is expected in the coming months. The Bureau’s paper highlights several key regulatory, technical, and procedural aspects of the current Canadian healthcare system that may hinder competition, and while lofty, can have a significant impact on the competitive landscape. We provide some recommendations.

Part 1 – Unleash the power of your health data

Canada’s healthcare system is rich in data, but healthcare providers struggle to transform this data into information they can use to innovate and improve patient care. first report, Unlock the power of health data, Canadian policymakers propose steps to improve access and sharing of personal health information, with the aim of fostering competition and innovation in the healthcare industry. With particular attention to primary health care electronic medical record (EMR) systems (that is, systems used to collect personal health information in family physician’s offices, hospitals, and other primary health care settings), The report identifies two major barriers to competition.

1. Differing privacy and data governance rules across states and territories create structural inefficiencies, resulting in fragmented markets and high entry costs for new entrants. As a result, there are only a handful of primary healthcare EMR companies currently competing in most states and territories, with PEI, Newfoundland and Labrador, Northwest Territories and Nunavut all Limited to one primary healthcare EMR provider.
2. Due to the lack of standards for data storage across primary health care EMRs, information is locked to the specific EMR system chosen by the primary health care provider and cannot be transferred to other health care providers using a different EMR, such as switching EMRs. It becomes difficult to share patient information with providers. Additionally, his EMR company in primary healthcare is acquiring other players in the healthcare space (virtual care providers, community clinics, etc.). While this opens up opportunities for vertical interoperability, it can also stifle innovation by these companies that limits the capabilities of other third-party his solutions. Interface with their EMR.

To achieve interoperability between primary health care EMRs and EMR systems in other healthcare settings (such as pharmacies), the Bureau recommends the following:

1. Uniform privacy and data governance rules across Canada – Looking to equivalent jurisdictions, the Bureau recommends the use of legislative tools (e.g. 21^st Century Cures Act in the United States) and digital solutions (such as Australia’s unified national electronic records system, ‘My Health Record’) to create a national health data plan. The National Health Data Plan simplifies market entry and expansion for domestic and international companies, fostering greater competition and innovation across the country.
2. Anti-compliance demands–blocking rule – Anti-blocking rules are rules that prevent healthcare EMR companies from interfering with the access, exchange, and use of electronic personal health information. Some of the characteristics of Canada’s recommended approach include encouraging compliance, establishing common standards for data storage and transfer, and requiring that the cost of data sharing is reasonable.
3. establish interoperability standards – The Bureau recommends that these standards be established, implemented and operated by an independent body, aligned with international standards and allowing flexibility to develop subsequent innovations.

Part 2 – Improving Healthcare with Competitive Procurement Policies

As public agencies are the primary purchasers of healthcare products and services in Canada, public procurement rules play an important role in determining who can contest contracts with the government and, in turn, Canada. driving competition and demand-side innovation in the digital healthcare sector. His second report for the Bureau focuses on how strategic use of government purchasing rules can bring greater competition, innovation and choice to healthcare providers and patients. In particular, the report emphasizes the role played by SMEs (“Small and medium-sized enterprises”) contributes to driving innovation and the need for public procurement processes that facilitate opportunities for these companies. Through consultations, the Secretariat has identified six barriers to competition in the public procurement process.

1. Health care is under state and territory jurisdiction and the federal government is under state jurisdiction. Canadian Health Act, which defines the national principles reflected in state and territory health care plans. This creates a fragmented procurement structure with 14 different jurisdictions, each with different priorities, laws, regulators and levels of centralization.
2. RFP requirements that are too stringent or inadequately scoped can exclude potential bidders, especially small businesses, who can propose innovative solutions.
3. A focus on price over value, quality, or results can deter innovators and small businesses that often cannot match the low prices offered by large companies.
4. Risk aversion can result in favoring established or known systems and vendors over new or innovative solutions.
5. Public procurement cycles may be overtaken by the pace of innovation. This means that products and services may become obsolete by the time the procurement process is completed. A lengthy procurement process can also slow return on investment for innovators and affect further product development.
6. Overly prescriptive policies (such as requiring the use of specific products or vendors) can drive potential innovators out of the market and eliminate procompetitive effects.

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

1. Establishment of a National Innovation Procurement Center for Expertise to Create a Canadian Roadmap for Implementing Innovative Procurement.
2. Public procurers should self-assess to promote competition, such as paying attention to the entire product or service lifecycle, how technological changes will affect current and future needs, and switching requirements between vendors. practices and remove barriers.
3. (1) the use of functional rather than technical requirements so that vendors can compete in ways that achieve desired results; (2) reduced paperwork to effectively facilitate SME participation; and (3) ) Flexible award criteria considering both quality and price.

next step

A third and final report is expected to be published in the coming months to complete the digital healthcare market study. The final report highlights issues not fully addressed in the first two reports, including health care provider compensation and policies limiting the expansion and delivery of digital health products, from consultations with the agency’s stakeholders. It will likely cover some of the common themes. and services, access, affordability, literacy and patient protection on digital solutions.