,
11 tweets,
2 min read
Read on Twitter
1/
#CuresNPRM pricing policy recommendations.
To start with, a basic question: are market forces for interoperability good, or nah?
#CuresNPRM pricing policy recommendations.
To start with, a basic question: are market forces for interoperability good, or nah?
2/
There are three basic positions that I hear articulated
a) "making money on interoperability is immoral"
b) "making 'unreasonable' profit on interoperability is immoral"
c) "extracting monopoly rents as an interoperability gatekeeper is immoral"
There are three basic positions that I hear articulated
a) "making money on interoperability is immoral"
b) "making 'unreasonable' profit on interoperability is immoral"
c) "extracting monopoly rents as an interoperability gatekeeper is immoral"
3/
These are obviously *very* different stances, and the inability to articulate and distinguish them causes real problems. I often hear a silent assumption that all fees are monopoly rents and ipso facto immoral.
These are obviously *very* different stances, and the inability to articulate and distinguish them causes real problems. I often hear a silent assumption that all fees are monopoly rents and ipso facto immoral.
4/
If you really believe in the basic immorality of selling interoperability products and services for health care, you'd probably want a socialized structure -- e.g., a state run public utility.
If you really believe in the basic immorality of selling interoperability products and services for health care, you'd probably want a socialized structure -- e.g., a state run public utility.
5/
Alas, we gave nearly $1Bn to states to setup HIEs under HITECH, and got pretty much bupkis for that funding. At the same time, I've been involved with multiple private efforts that have raised 2 orders of magnitude less capital & have delivered more.
Alas, we gave nearly $1Bn to states to setup HIEs under HITECH, and got pretty much bupkis for that funding. At the same time, I've been involved with multiple private efforts that have raised 2 orders of magnitude less capital & have delivered more.
6/
So I have a perspective here -- throw stones at me, or whatever, if it makes you feel better -- I stand by my interoperability work in health care, both in the public & private sector.
So I have a perspective here -- throw stones at me, or whatever, if it makes you feel better -- I stand by my interoperability work in health care, both in the public & private sector.
7/
So here's an alternative position that addresses the problem of monopoly rents without creating a net disincentive for market actors to address unmet needs:
Tailor pricing regulation at actors that are in positions of being gatekeepers.
Datsit.
So here's an alternative position that addresses the problem of monopoly rents without creating a net disincentive for market actors to address unmet needs:
Tailor pricing regulation at actors that are in positions of being gatekeepers.
Datsit.
8/
When are you a prospective gatekeeper? When you are the only reasonable actor who can make data available to requestors. When are you not a gatekeeper? When your services are not essential to making data available, or have reasonable alternatives.
When are you a prospective gatekeeper? When you are the only reasonable actor who can make data available to requestors. When are you not a gatekeeper? When your services are not essential to making data available, or have reasonable alternatives.
9/
So you are a prospective gatekeeper when you make, operate or control health IT (as a vendor or provider); you are not a gatekeeper when there is objectively a market for the type or class of services you provide, or reasonable substitutes that other actors use.
So you are a prospective gatekeeper when you make, operate or control health IT (as a vendor or provider); you are not a gatekeeper when there is objectively a market for the type or class of services you provide, or reasonable substitutes that other actors use.
10/
If you are a gatekeeper, you have to provide the raw data you control at cost; if you license essential IPR to enable raw data to flow, you must provide it on FRAND terms.
If you are a gatekeeper, you have to provide the raw data you control at cost; if you license essential IPR to enable raw data to flow, you must provide it on FRAND terms.
11/
If you are not a gatekeeper, let a 100 flowers bloom, let 100 schools of thought contend. You are a gatekeeper, let's get all Nicolas Maduro on your rear end.
Simple.
If you are not a gatekeeper, let a 100 flowers bloom, let 100 schools of thought contend. You are a gatekeeper, let's get all Nicolas Maduro on your rear end.
Simple.
