'Rhetoric over substance': Why athenahealth won't participate in ONC's transparency attestation

In early June, the ONC released transparency requirements for IT developers that mandate certain public disclosures about product costs, functionality and specifications. Additionally, developers are required to submit an attestation that indicates whether they will take additional and voluntary actions to further promote transparency. Many vendors declared intent to take these additional actions, but one is noticeably missing: athenahealth. 

The ONC implemented this developer transparency initiative to help health IT purchasers better understand the capabilities and limitations of products and to promote competition. The agency also is trying to shore up developers' accountability regarding product cost and performance.

According to the ONC, such voluntary actions developers may take to promote transparency include "engaging in open dialogue about their business practices and making such information available to potential customers and others in more targeted and useful ways."

But athenahealth doesn't believe these attestations are the way to do that.

Dan Haley, senior vice president, general counsel and corporate secretary for Watertown, Mass.-based athenahealth, says the transparency attestation is "rhetoric over substance."

"The request is the promise to be transparent. If you promise to be transparent, you get a gold star. And if you don't, you get a lump of coal. That's regardless of what your actual practices are in the marketplace," Mr. Haley says.

What the ONC is asking developers to voluntarily commit to do is what they should already be doing, Mr. Haley suggests, and any developer that isn't communicating clear and useful information with their clients is bound to run itself into the ground.

"We assume that if a healthcare organization decides to call up athenahealth, they've done that because the information we've provided is adequate to make that decision," Mr. Haley says. "A vendor that doesn't provide adequate price information to its marketplace will likely find itself without much of a market. That's just how it works."

Mr. Haley says it isn't the government's place to step in and require vendors to provide certain information to customers for the stated purpose of helping customers make purchasing decisions. That, he says, is the role of the marketplace and consumers, who can simply ask a vendor for any information needed to make an informed purchasing decision. And, vendors who want to be successful will provide that information.

In comments to Becker's Hospital Review, a spokesperson for the ONC reiterated that such requirements of the vendors support the marketplace and will ultimately benefit the consumer. "The approach is about helping the market work: When purchasers are better informed, vendors must innovate and compete to offer customers the best products, capabilities and prices," according to the spokesperson.

Mr. Haley says athenahealth is confident in its transparency and is not concerned that its decision to not sign the attestation will affect relationships with customers. He underscores that athenahealth's decision to not participate in the voluntary attestation doesn't mean the vendor isn't committed to transparency or other efforts to improve the marketplace. He points to athenahealth's pricing structure as one example of this. The company does not sell or lease software licenses; rather, it shares in revenue clients bring in from using athenahealth's platform. The company, essentially, gets paid for performance, and Mr. Haley says a lack of pricing transparency is not a complaint the company hears from clients.

So why not just sign the attestation? If providing this information and support to clients is something athenahealth already does, what's the harm in signing the transparency initiative?

Mr. Haley says doing so would set a bad precedent and would be a drain on resources.

"It acquiesces to this notion of regulation by loyalty pledge. We don't think it's a good precedent to set," Mr. Haley says. "We don't think this is in [clients'] best interest for us to bury our communication team in a bunch of disclosures."

More articles on the ONC:

ONC too focused on quantity of interoperable information, not quality, orgs say 
AHA suggests redefining the scope of interoperability 
Certified EHR adoption 'nearly universal' in acute care hospitals: 4 statistics from the ONC 

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