On the specific issue of market incentives and business objectives:

• Healthcare suffers from a fragmented and stalled market for IT—both for connectivity and IT adoption generally.
• There is no "network effect" today in healthcare IT.
• The promulgation of a Common Framework will immediately accelerate the value of adopting IT by creating confidence in the ability of IT systems to reliably enable connectivity. Agreement on conformance validation mechanisms for interoperability will enhance this effect.
• This approach should catalyze a market by creating a level playing field for market competition. Nevertheless, widespread adoption of interoperable clinical IT will still depend on investment in the key components of the Health Information Environment and the use of incentives that recognize appropriate information use in clinical care.
• Incentives can include a wide variety of options from fundamental payment reform to eligibility for Federal assistance, eligibility to participate in federal demonstration projects, private-sector pay for performance incentives that require interoperability specified by the Common Framework, and eligibility to receive private IT adoption assistance.
• Incentives that reward the improved decision-making and quality of care enabled by the Health Information Environment will be more effective at driving participation than incentives tied specifically to IT adoption or network participation.