The COVID-19 pandemic has reinvigorated curiosity in modernizing Canada’s well being care system. For its half, the Competitors Bureau (“Bureau”) has undertaken a digital well being care market research, inspecting how professional‑aggressive insurance policies can foster innovation and convey about higher selection and entry to digital well being care providers for Canadians. After consultations with a variety of stakeholders, the Bureau revealed its first report on the aggressive function of non-public well being info in June 2022, adopted by a second report in October 2022 on bettering well being care by means of pro-competitive procurement coverage. A 3rd and last report is anticipated to observe within the coming months. The Bureau’s papers spotlight some key regulatory, technical and procedural elements of the current Canadian well being care system which will hinder competitors, and supply a number of suggestions that, whereas lofty, have the potential to considerably affect the aggressive panorama.
Half 1 – Unlocking the Energy of Well being Information
Whereas Canadian well being care programs are knowledge wealthy, well being care suppliers have struggled to transform this knowledge into info that can be utilized to innovate and enhance affected person care. The primary report, Unlocking the Energy of Well being Information, proposes steps for Canadian policymakers to enhance entry to and sharing of non-public well being info with the goal of selling competitors and innovation within the well being care business. Trying particularly at main well being care digital medical report (EMR) programs (ie, programs used to gather private well being info in household physician workplaces, hospitals and different main well being care settings), the report identifies two key boundaries to competitors:
- Disparate privateness and knowledge governance guidelines throughout the provinces and territories create structural inefficiencies, leading to market fragmentation and excessive entry prices for brand spanking new gamers. In consequence, solely a handful of main well being care EMR firms presently compete in most provinces and territories whereas PEI, Newfoundland and Labrador, Northwest Territories and Nunavut are restricted to a single main well being care EMR supplier.
- With no requirements for knowledge storage throughout main well being care EMRs, info is locked into the precise EMR system chosen by a main well being care supplier, making it troublesome to change between EMRs or to share affected person info with different well being care suppliers utilizing a special EMR. Moreover, main well being care EMR firms are buying different gamers within the well being care area (digital care suppliers, group clinics, and many others.) which expands alternatives for vertical interoperability however also can stifle innovation the place these firms restrict the power of different third social gathering options to interface with their EMR.
To attain interoperability between main well being care EMRs and with EMR programs in different healthcare settings (eg, pharmacies), the Bureau recommends:
- Harmonized privateness and knowledge governance guidelines throughout Canada – seeking to peer jurisdictions, the Bureau recommends the usage of legislative instruments (eg, the 21st Century Cures Act in america) and digital options (eg, “My Well being Report”, a uniform nationwide digital report system in Australia) to develop a nationwide well being knowledge plan. A nationwide well being knowledge plan would simplify market entry and growth for home and worldwide firms, driving higher competitors and innovation throughout the nation.
- Requiring compliance with anti–blocking guidelines – anti-blocking guidelines are people who would stop well being care EMR firms from interfering with entry, alternate and use of digital private well being info. Really useful options for an strategy in Canada embody incentivizing compliance, establishing a typical commonplace for knowledge storage and switch and requiring that the price of knowledge sharing be cheap.
- Set up interoperability requirements – the Bureau recommends these requirements must be established, enforced and operationalized by an unbiased group, aligned with worldwide requirements and permit for flexibility to develop follow-on improvements.
Half 2 – Bettering Well being Care By way of Professional-Aggressive Procurement Coverage
Since public entities are the principle consumers of well being care services in Canada, public procurement guidelines play a key half in deciding who can compete for presidency contracts and, in flip, drive competitors and demand-side innovation in Canada’s digital well being care sector. The Bureau’s second report focuses on how strategic use of presidency buying guidelines can result in higher competitors, innovation and selection for well being care suppliers and sufferers. Specifically, the report emphasizes the function that small and medium enterprises (“SMEs”) play in driving innovation and the necessity for a public procurement course of that facilitates alternatives for these firms. By way of its consultations, the Bureau recognized six boundaries to competitors within the public procurement course of:
- Well being care falls below provincial and territorial jurisdiction, whereas the federal authorities, below the Canada Well being Act, defines the nationwide rules mirrored in provincial and territorial well being care plans. This creates a fragmented procurement construction of 14 completely different jurisdictions, every with completely different priorities, statutes, regulatory authorities and ranges of centralization.
- Overly strict or improperly scoped RFP necessities can remove potential bidders, notably SMEs, that may deliver ahead revolutionary options.
- Concentrate on worth over worth, high quality or outcomes can hinder innovators and SMEs that usually can not match the decrease costs provided by bigger firms.
- Danger aversion may end up in favoring established or identified programs and sellers over new or revolutionary options.
- Public procurement cycles will be outpaced by the speed of innovation, which means that services will be outdated by the point a procurement course of is full. Prolonged procurement processes also can delay the return on funding to innovators, impacting additional product improvement.
- Overly prescriptive insurance policies (eg, requiring use of a particular product or vendor) can push potential innovators out of the market and remove pro-competitive results.
To handle these boundaries and foster competitors and innovation by means of procurement insurance policies, the Bureau recommends:
- Establishing a nationwide innovation procurement heart for experience to create a Canadian roadmap for the implementation of revolutionary procurement.
- Public attorneys self-assessing their practices and eradicating any boundaries as a way to favor competitors, corresponding to consideration paid to the complete life cycle of a services or products, how modifications in expertise may have an effect on present and future wants, and any switching necessities between distributors.
- Supporting innovation-friendly procurement processes together with (1) the usage of useful reasonably than technical necessities to permit distributors to compete on methods to realize desired outcomes, (2) lowering pink tape to successfully facilitate SME participation, and (3) the usage of versatile award standards that contemplate each high quality and worth.
To finish the Digital Well being Care Market Research, a 3rd and last report is anticipated to be revealed within the coming months. The ultimate report will doubtless cowl a few of the widespread points that emerged from the Bureau’s session with stakeholders that haven’t been absolutely addressed within the first two stories, together with compensation of well being care suppliers, insurance policies that restrict the growth and supply of digital well being care services, enhancing entry, affordability and literacy concerning digital options, and affected person safety.