A Practice Fusion coda: an insider’s perspective on the pressure to ethically breach an ‘objective’ service for revenue

From both sides: an insider at Practice Fusion, then a regulator at ONC. Mentioned briefly in POLITICO Morning eHealth is a blog posting from a former ONC (Office of the National Coordinator, HHS) official, Jacob Reider, MD, about Practice Fusion. Before he was Deputy National Coordinator of Health IT, he was CMIO of Practice Fusion circa 2009-11. His blog has some interesting insights on even ten years ago, how aggressive pharmaceutical companies were in wanting to ‘bend’ (Editor’s term) clinical decision support (CDS) in the EHR to promote a drug category, and in a young, growing, and revenue-hungry company, the temptation for ‘growth’ teams to do so. Fast forward a few years, and Dr. Reider is working to write the certification requirements for EHRs and the evidence (via citations) for CDS. His conversations with the then-CEO, Ryan Howard, about the ethics of their advertising model and their rationale illustrate the conflict between ethics and revenue–as in right up to the line and looking over. While this is familiar to any media observer–after all, why buy advertising if not to change behavior?–when decisions are being guided by an EHR, the CDS shouldn’t be rigged, visibly or invisibly. Dr. Reider places the crossing of the line after Mr. Howard’s departure with a new pharma-minded team. The evidence in the CDS lies in the citations funded by–pharma and biomed companies. The inevitable result: Allscripts, now the owner, settling for $145 million with the DOJ and having ‘kickbacks’ attached to their business. Dr. Reider is now CEO of the Alliance for Better Health in Albany, NY. Docnotes: When sponsored CDS is a crime

This is hardly the first instance of the blurring of boundaries between ethics and revenue. All those paying to get their genetic history from 23andme or Ancestry.com ought to consider that they may also be signing on to have their information used by a medtech company for research. It may be stripped of PII and ‘de-identified’, but there are ways of cross-referencing some of that information. Why else would GSK own 50 percent of the company? [29 Aug 19, 31 Oct 15]