Computers ignore the Hippocratic oath
Spring 2020
We all know that that there is no such thing as a free lunch online. Google, Facebook, Twitter and others provide their services for nothing in return for placing adverts under our noses. As the saying goes, if you are not paying for a service, it’s because you are the product they are selling.
Most of us understand that nowadays and we make allowances.
Unfortunately, in January a much grubbier use of freely acquired data was revealed at the conclusion of some American court cases.
When you visit your doctor, the details of your health are recorded on a computer. Do you know what happens to those records? If it’s an NHS doctor, the rules are very strict, but that is not the case everywhere.
Practice Fusion is a website used by over 30,000 American doctors; it allows a medical practice to keep its records efficiently. Appointments, consultation records, prescribing, invoicing and so on are managed by it, and apparently managed well. Organising a surgery is notoriously challenging, especially for smaller ones, and doctors were pleased that this website seemed to offer a solution.
Even better, it used to be free to use; the overheads were covered by advertising. I imagine that advertisers are prepared to pay well to reach such a precisely chosen and well-paid group of people.
I don’t mind that; I’d hope that doctors can spot an advert and judge its merits accordingly.
Sadly, that wasn’t the end of it. The website’s squalid secret was that it took money to manipulate its software in order to encourage doctors to prescribe a particular manufacturer’s opioid painkillers.
It worked like this: doctors would use the website whilst they examined a patient, entering symptoms on each patient’s records. Once entered, the website, claiming to be providing unbiased medical opinion, would analyse the records and produce what they called a ‘clinical decision support alert’ (a popup) suggesting a course of treatment, including appropriate drugs. Apparently, from 2016 to 2019, this happened over 200 million times.
But that opinion was far from unbiased. Practice Fusion has admitted that it sought and received payments from a major drug company in exchange for ensuring that the alerts would favour that drug company’s products, thus increasing the number of prescriptions issued. Sometimes they even allowed the drug company to draft the wording of the alerts.
Their marketing approach was centred on improving the drug company’s sales; patients’ wellbeing does not seem to have been mentioned. Indeed, the US Department of Justice has said that these alerts ‘did not always reflect accepted medical standards’. Something of an understatement, I suspect.
The local U.S. Attorney described Practice Fusion’s conduct as ‘abhorrent’. I can only agree. It’s also been a disaster for the respectable company Allscripts that bought Practice Fusion for $100 million in 2018 and which must now cough up $145 million to resolve various court cases, including a $26m million criminal fine. Allscripts is one of the accredited suppliers of electronic patient record services to the NHS, by the way.
We should all be aware that the data revolution in the world of medicine (as elsewhere) is still in its infancy but is growing fast. This is usually to our benefit, but the Practice Fusion episode shows just how easily electronic health records can be manipulated for financial gain, rather than for the best care of patients.
I don’t believe new laws are needed, I think the old ones are fine, as Practice Fusion has discovered. But they do need enforcing; there are many similar electronic health records companies. This is the first criminal action against one; I wonder if it will be the last.
It all makes my blood boil and run cold simultaneously, if that’s possible.
A few links...
Details of how the NHS treats the information they have on you
NHS announcement of accredited suppliers for electronic patient records in the UK
The United States Department of Justice’s press release about Practice Fusion
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