Quasi-Monopoly Status of a Non-for-Profit Reference Terminology Provider – An Exemplary Approach on Transparency Improvement Regarding Licensing

As the reference terminology SNOMED CT is gaining in significance and seems without alternative in interoperable Electronic Health Records, the holder of its intellectual property, the non-for-profit organization SNOMED International has achieved a quasi-monopoly status as a provider. We examine the current dealing with corporate transparency regarding SNOMED CT licensing together with policy recommendations derived from the research project ASSESS CT, in the context of collaboration with Standardization Organizations. In addition, transparency improvement is proposed based on the economic Principal-Agent-Theory, assuming SNOMED CT Licensees as principals. In this paper we introduce improvement measures with regard to increase transparency in the licensing process addressing to the reference terminology users and especially the terminology provider. The aim is to present strategies towards transparency, with the intent to remove barriers concerning indecisive organization stakeholders and users of a license and fee-based terminology solutions, as well as to overcome resentments connected to the quasi-monopoly status of the provider.