(Corrects spelling of drug to Pristiq, not Pritiq, in paragraph
By Beth Pinsker
NEW YORK Jan 8 If you went to visit your doctor
and a drug company representative was sitting in the room with
you, ready to hand out pamphlets and samples, you'd likely cry
Depending on what electronic health record system your
physician uses, the digital version of this sort of thing is
New regulations in the Affordable Care Act restrict access
to doctors by pharmaceutical companies. As a result, drug
companies are finding their way behind the medical industry's
closed doors via digital record-keeping systems.
These systems are able to crunch a lot of health information
and spit out reports, stripped of data identifying specific
patients, that the pharmaceutical industry finds useful.
The process is not altogether shocking. Drug companies have
been able to gather data for years from insurance company
records, pharmacies and public records. Unlike the disconnected
reports of yesteryear, these new data analyses come with the
potential to reach back through the system via email or pop-up
ads and directly target doctors and patients - both for medical
and marketing purposes.
The problem is that consumers don't want health information
used to sell them medical services. They also don't want their
doctors' medical judgment to be compromised by the financial
clout of the pharmaceutical industry.
"We expect our physicians to be acting in our best
interest," says Farzad Mostashari, a visiting fellow at the
Brookings Institution who was formerly the National Coordinator
for Health IT at the U.S. Department of Health and Human
Services. If a patient confides in a doctor about an ailment,
and then gets a mailing about a possible treatment, "that would
be pretty upsetting," Mostashari adds.
Electronic health records were developed to streamline
workflow and make patient data useful to doctors, says Mary
Griskewicz, senior director of health information systems at
HIMSS, a non-profit promoting health information technology.
Marketing, Griskewicz adds, "wasn't the intent."
POP UP ADS
What exactly is going on between your doctor's tablet and
When doctors at the Heart of Wellness clinic in Olympia,
Washington, log on to their network to update patient data, they
see advertising. Sometimes it's just house ads from Practice
Fusion, the software company that operates their system, and
sometimes it's full-color ads for prescription drugs such as
Pristiq, a depression drug from Pfizer Inc, the kind any
consumer might see on a public website.
Practice Fusion is free for physicians who accept seeing
advertising and letting the company crunch the data that results
from patient files. This is just one of the payment models in
the highly fragmented electronic health record marketplace,
which involves dozens of companies, none with significant market
Practice Fusion reaches over 100,000 physicians and
processes some 80 million patient visits a year, which is about
3 percent of the market, according to government data.
"We're an alternative holistic practice - we don't prescribe
a lot of drugs. So we weren't influenced by (the ads) at all,"
says Logan Obermire, creative director of Heart of Wellness,
which is in the process of switching to a paid system.
Two of biggest companies, Cerner Corp and Epic Corp
, deal with large hospital groups, and offer monthly
fee-for-service plans. Both say they do not sell patient data.
Other systems, like Kareo, offer free basic services, but
heavily push additional paid services. There's even a model,
Hello Health, that asks patients to foot the bill with a monthly
fee to access their records.
It's not the price of the service that necessarily
determines the levels of privacy protections for consumers.
Beyond overt advertising, there are various uses for the
analysis of consumer data.
Medical purposes abound. Data that has been stripped of
names - what is called "de-identified" in the industry - can be
used to track outbreaks and fine-tune treatments. AthenaHealth
Inc, which has about 5 percent of the market, says it
used de-identified patient data this fall to construct its own
flu tracker when the Centers for Disease Control had to suspend
its effort during the government shut-down.
There is a slippery slope when it comes to de-identified
data and electronic health records, says Adriane Fugh-Berman, a
doctor who is director of PharmedOut, a research and education
project at Georgetown University Medical Center. The digital
systems can email reminders to patients to refill medications or
encourage them to get vaccines. It's not always clear who is
paying for those messages and if the content is from the doctor
or some kind of advertorial.
"It's extremely misleading to patients," Fugh-Berman says.
Practice Fusion chief executive Ryan Howard says his company
has campaigns for vaccine reminders that are funded by
pharmaceutical companies, passed along to patients via emails
that come in the doctor's name.
"The doctor has opted in to have us message the population,"
Practice Fusion does not sell data to third parties, it is
all kept in their own cloud, Howard says. The San
Francisco-based firm crunches data internally and then makes
some of the results available for sale, like how many adult men
and women in their patient universe have not had a Hep A
"We never disclose any private health info or doctor-level
data either," Howard adds.
The only way currently for patients to figure out what is
going on is to ask their doctors who runs their portals and find
out exactly what's in the small print, says Christopher
Tashjian, a physician in Ellsworth, Wisconsin.
In reality, "most people are not that interested in where
their data might go," says Jon Handler, a physician who is the
Chief Medical Office for M*Modal, a healthcare technology
services firm. "Almost everyone will say yes to letting the
insurance company get their data in order to process their
Patient privacy and patient health are both really
important, Handler says. "We just need to do a better job in
finding ways to make sure those two things are not at odds with
other," he adds.
(Follow us @ReutersMoney or here.
Editing by Lauren Young and Andrew Hay)