The New York Times reported this week that the Federal Trade Commission has raised concerns in Ohio and elsewhere about anti-competitive effects of mergers in the health care sector. Those involved in the deals, though, state that the intent of the recent health care reform act was to enable and encourage such consolidation.
I covered this topic a year ago and then in November, predicting the arguments that would be used by the proponents, just as seen in the Times story:
Randy Oostra, the president of ProMedica, said the merger would benefit patients in many ways. “We could coordinate care,” Mr. Oostra said. “We could improve quality at St. Luke’s by adopting electronic health records and using clinical protocols to standardize the delivery of care. But the F.T.C. has stopped us in our tracks."
Of course, it is possible and desirable to coordinate care and improve quality even without creating behemoths of market power. Corporate integration and common ownership is in no way a necessary condition for such improvements, whether the parties are non-profit or for-profit. Requiring all electronic health record systems to be mutually compatible would also go a long way to ensuring that proprietary information systems do not become the tail that wags the dog of corporate consolidation.
Academic medicine is particularly at the axis of a clear choice: is data available by means that maximize information sharing (speeding science and its ability to alleviate disease) or is a patient's data the means to maximize the goals of business? What makes us any different from the insurers we glibly blame?
ReplyDeleteAs these systems mature, patients should begin asking their lawyers not what the doctor did wrong, but what is in the algorithm that determine their care. This is why 'proprietary' should mean patient-owned data, and the paternalism of medicine is on shaky ground. 'Disclosure' laws should include EHRs as rightfully transparent.