That could be the very definition of preventive care in the electronic era.
But what if all these processes were paid for, at least in part, by a pharmaceutical company that retains the right to have access to all of that personal information and insists upon using it so send the doctor and you advertisements about its own medications? Or if a health insurance company seizes the same opportunity? Or anyone else for that matter?
And what if the corporation in question was under financial pressure to sell more of whatever? Or if unscrupulous executives were more concerned with financial performance and their bonus formulae than with your particular needs?
Yes, interesting opportunity. Assuming it can be managed with discretion and sensitivity to the needs of the patient. JL
Elizabeth Dwoskin reports in the Wall Street Journal:
When Allan Treadwell views patient charts on his computer, a yellow alert sometimes pops up—a handy feature that tells him when a patient is due for vaccines for hepatitis B, influenza or other ailments.It’s a fine line between recommending some kind of guidelines-based care versus recommending something that is marketing or sales-driven.
“It’s a nice safety net,” said Dr. Treadwell, an internist in San Francisco.
Dr. Treadwell isn’t the only one who is pleased with the alerts. So is Merck & Co., which pays for the notifications sent to Dr. Treadwell and 20,000 other health-care providers. Medical-record software startup Practice Fusion Inc., which sells the alerts and displays them through its software, said that during a four-month study period ending in August, it observed a 73% increase in vaccinations—amounting to 25,000 additional treatments—compared with a control group. The company didn’t disclose its fees for delivering sponsored alerts but said it doesn’t take a cut of sales that result.
Practice Fusion, which has raised $157.5 million from investors, is pioneering a new type of data-driven business. Health-care providers increasingly use software to keep patient records. Many of these programs alert doctors when the information stored there indicates that a patient needs a particular treatment. Practice Fusion has taken the opportunity to sell sponsorships for alerts to drug companies and others.
The startup, which gives its software to clinics free of charge, crunches 100 million patient records it has stored remotely in an online database to alert providers when treatments or tests might be needed. Some of those messages are sponsored, letting marketers deliver the ultimate nudge: a subtle pitch to the right doctor, about the right patient, at the right moment.
Some experts worry that Practice Fusion’s sponsored alerts blur the line between promoting health and marketing medicines.Advertisement
The software Practice Fusion gives away “would otherwise cost you $30,000,” said Dr. Robert Wachter, associate chairman of the Department of Medicine at the University of California, San Francisco. Anti-kickback laws forbid drug companies from paying doctors directly or indirectly to prescribe their products. Free software subsidized by drug companies could be seen as an undue incentive, he said.
“It’s a fine line between recommending some kind of guidelines-based care versus recommending something that is marketing or sales-driven,” said Dr. Joseph Kvedar, vice president of connected health at Partners Healthcare, a nonprofit hospital system affiliated with Harvard Medical School. “It’s dicey.”ENLARGE
Practice Fusion and other makers of clinic software can reach doctors at a time when drug companies’ traditional marketing methods have been curtailed. Some health-care institutions bar visits from pharma sales reps, and laws require public acknowledgment of gifts from drug makers to doctors and academic medical centers, putting a damper on lavish events.
In a November 2014 article in the New England Journal of Medicine, three doctors wrote that electronic medical-record systems create “new pathways for reaching physicians, allowing the delivery of marketing messages at the point of care, when clinical decisions are being made.”
Practice Fusion Chief Executive Ryan Howard said the alerts help make doctors more effective by delivering timely, helpful information. “Someone has to pay for it,” he said. Practice Fusion says about 112,000 health professionals, doctors and nurses are using its system and the software logs about 5.5 million office visits a month.
Practice Fusion matches preprogrammed alerts with patients in real time based on their health indicators and medical history, much like an online advertising system places a particular ad on a Web page depending on the user’s browsing history. When a doctor loads a patient’s profile, the software responds with relevant messages.
Drug makers, labs and insurance companies can pay for alerts, banner ads or sales ordered through the software. Practice Fusion also sells anonymized, aggregated data from patient records to drug companies and other customers. For instance, a drug maker may buy statistical information about prescribing patterns of doctors on the system.
Epic Systems, a leading U.S. provider of electronic health-record software that makes money by selling its program, delivers alerts but doesn’t sell sponsorships. Athenahealth Inc., a smaller competitor with Practice Fusion, doesn’t sell sponsored alerts in its patient record software but does in its medical reference mobile app. It takes a cut of transactions that are processed by its software.
Colleen McGuffin, Merck Vaccines’ vice president of global customer and U.S. commercial operations, said Practice Fusion’s sponsored vaccination alerts were so effective she was looking for further opportunities. She declined to say how much Merck paid for the sponsorship or how much revenue the program brought the company.
Alerts are becoming valuable to doctors and hospitals, Dr. Kvedar said. They may lead to better patient outcomes, which increasingly affect the size of insurance reimbursements. They can also tell doctors how they compare with peers; Practice Fusion offers doctors a scorecard showing how their quality-of-care metrics stack up against those of other physicians on the platform.‘It’s a fine line between recommending some kind of guidelines-based care versus recommending something that is marketing or sales-driven’
Mr. Howard said he took pains to make sure Practice Fusion’s vaccine alerts adhered strictly to government and industry guidelines. He also vetted the sponsorship program with independent lawyers who are experts in the field, he said.
Moreover, he said, Merck had no opportunity to influence prescriptions or promote its own drugs over alternatives. Although Merck was the sole supplier of three of the vaccines that have been subjects of its sponsored alerts, it faced competition for one other, and it didn’t compete in the market for two.
The Centers for Disease Control and Prevention determines recommended vaccine schedules. Doctors had to opt in to alerts, and messages sponsored by Merck were marked as such, Mr. Howard said. The sponsor’s name, if there is one, appears after the label “funding source” at the bottom of an alert.
Dr. Treadwell said he wasn’t aware Merck paid for alerts until he discovered the sponsorship by clicking through several screens.
While Practice Fusion’s sponsored alerts may raise ethical questions, they don’t necessarily violate kickback laws or imply that a physicians judgement is being clouded, said Ramy Fayed, a Medicare fraud expert at the law firm Dentons. Opting into sponsored alerts wasn't a precondition for receiving free software, so contending a doctor was paid by a sponsor would be a long shot, he said.
Patients may still want to know about it, Dr. Wachter said.
Practice Fusion is plowing ahead with alerts and other ways to build a business on the data it collects. It has cut a deal to deliver sponsored alerts for Aetna Inc., and it plans to announce a partnership with another large drug maker that includes sponsored alerts for asthma drugs.
Mr. Howard said he believed his company’s platform could benefit public health. It could spot doctors who frequently prescribe often-abused drugs like OxyContin or find patterns that indicate impending disease outbreaks. However, he said, it was important to weigh the public-health mission against the imperative to build a sustainable company.
“For every project we do that drives forth public health or gives data away,” he said, “we need to make sure it’s balanced out by a monetizable exercise.”
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