At a Feb. 6 meeting of the Health IT Policy Committee, National Coordinator for Health Information Technology Farzad Mostashari, MD, said that, by and large, electronic health record vendors have their customers’ best interests at heart. But to the few who don’t, he gave a stern warning: Abide by what is "moral and right," or face more regulation.

Mostashari’s comments came by way of clarification to opening remarks he gave at last month's HIT Policy Committee meeting. He wanted to make sure that the vendors who are doing right by providers and society’s interest do not mistake him for coming down on them. He was speaking to the few exceptions, when he made remarks at the Jan. 8 meeting, as contained in these meeting minutes:

"Mostashari reported on Jonathan Haidt’s The Righteous Mind, relating Haidt’s conclusions on competition and group selection to the task at hand. Talking about morality, social control, solidarity and authority, Mostashari recognized that not every problem could be solved via authority. Governmental regulation is one means of control, but may not be as effective as social norms. He declared that legal and right are different. ONC has called on the layer between self-interest and government regulation and is calling on moral behavior. He spoke of professionalism and fairness, cheating and harm, saying that he wishes to use all tools at his disposal to encourage societal enforcement of norms."

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“Vendors do the bulk of the heavy lifting, but as a society, sometimes competition is not in the public interest," Mostashari said at the latest Feb. 6 meeting. “Government regulation can help in that case, but it’s not the most preferable way.”

"There are some vendors who are 'beyond the pale' in their conduct, and it is part of society to create codes of conduct to say this is what we believe in and this is what we do not believe in," he added.

Mostashari said that some vendors go beyond the boundaries of what society views as proper, in their lack of opaque pricing. He said he gets complaints from providers on a daily basis, saying that some pricing or contract requirements are unfair to them, and asking if there could be some federally regulated norms around pricing.

Data lock-in is another area where some vendors take advantage, Mostashari said. "It is not in the patients' and providers' best interests. We will take regulatory action where needed," he said. “We can’t have it purely be a function of, “I will do what is legally required of me, no more and no less.'"

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Some vendors include what Mostashari called "chilling language" in their contracts that discourage providers from moving to another vendor. These vendors may tell providers they will lose the ability to report safety events. Mostashari said there is no explicit language in the current meaningful use regulations to prohibit this. “We are expecting vendors to step up,” he said, “but if we have to, we will go back to the regulatory process.”

Mostashari apologized for using a "broad brush" on the vendor community – "by and large they are meeting the needs of their customers, and doing right by their customers."

He also urged customers to act together, so that "as part of a community, we can get to where we need to go on data usability and safety."