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Health-records software pushed opioids to doctors in secret deal with drugmaker

bloomberg.com

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Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#131

Post by dreamcompiler »

codeulike wrote: post #33
banads wrote: post #32

Earlier quoted context omitted.

I want to think this is bad, but the way it is described here doesn't really seem like a dark pattern to me. Maybe if "perscribe opiods" was the first or default selection, it would seem worse

It was built to be defensible/deniable. The fact that it was paid for by a pharma company is the problem. A doctors workflow shouldnt really be cladestinely influenced by a pharma company

> A doctors workflow shouldnt really be cladestinely influenced by a pharma company

Yet it has always have been so. Doctors are the gatekeepers of drug delivery, so big pharma has always pressured them. Doctors didn't push back (much) because they're too busy to keep up with pharmacology developments on their own, so the drug companies have offered such "education" as a helpful "service". (Said service always conveniently neglects to describe the benefits of older, still-useful drugs because they don't make any money.) The innovation of the 80s was the legalization of prescription drug advertising, which effected an additional pressure source for doctors to prescribe certain drugs: Their patients.

Now this happens where the software doctors are forced to use puts even more pressure on doctors. People talk about the evils of big pharma all the time, but most have no idea how great the evil really is.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#132

Post by rayhendricks »

“ The San Francisco-based company was founded in 2005 and became known for its unique model of providing free, ad-supported health-records software to independent doctors.”

I thought we have some of the most expensive doctors in the world, why can’t we get paid ehr software? The ceo responsible for this mess is Tom Langan. Why we are not able to put him in jail for a year is still a mystery. This is pure evil.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#133

Post by shigawire »

stevula wrote: post #112
conanbatt wrote: post #44

Earlier quoted context omitted.

It's made in Visual Basic, and it literally cannot interact with its own versions. Hospitals have different versions of the same system in the same building and cant exchange information. All EMR's suck though. (note: I made one)

I’ve always heard it was programmed in MUMPS

MUMPS in the back. Front is c# and typescript replacing the much maligned VB.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#134

Post by rscho »

skwb wrote: post #82
to11mtm wrote: post #42

Earlier quoted context omitted.

Also, I've never heard a good thing about Epic...

It's very du joure to talk bad about Epic (and certainly not without reason re: HHS healthcare interoperability proposed rules) but they have been a huge success from a business perspective. The reason why they provide EHR support for the majority of large healthcare system hospitals is that they provide a lot of flexibility to implimentation. If you want the ability to support some very unique functionality, they wi…

Epic is far, far away from what us MDs imagine when someone mentions the benefits of EHRs.

For starters, if one could make an EHR that just only attempts to also help practitioners in the trenches instead of just the billing dept. that would be stellar!

So 'the value EPIC brings' is huge... for anyone but care providers, thank you very much.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#135

Post by bryanrasmussen »

icoder wrote: post #29
CoolGuySteve wrote: post #27

Earlier quoted context omitted.

Why shouldn’t you implicate the developer? If your manager asks you to implement something that can kill people you have a moral obligation to quit. Whoever implemented this is as much of a shitbag as the executive who asked for it.

As I understand it, a developer could implement this without any knowledge of the secret deal: when opening a patients records a pop-up should appear. That's basically what the physicians would know after a using it for while too.

hmm, but rereading you are right someone could implement this without knowing about the secret deal, but different people are different and I have definitely worked with people who would say "why this" and then "business wants it", "hmm, that only makes sense if X or Y", heck I might even do it sometimes just trying to think about why things are put together the way they are - but you're right, some people won't, so maybe the developers who implemented it all never stopped to think "but why?"

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#136

Post by kube-system »

dkarras wrote: post #90

As a non-American I'm also curious about the mass necessity of opioid painkillers to begin with. From what I hear, people are prescribed opioids post surgery etc. which is bonkers to me as a foreigner. I'm a middle aged person and I have never seen anyone using opioid painkillers anywhere in my life. They give stuff to you when you are having surgery, and when you are in hospital's care, but something very extraordin…

'Opioids' is a pretty wide category though.

I don't think something like a short-term prescription for low dose codeine/acetaminophen cough syrup is really a big deal. Stuff like that can even be over the counter in a lot of developed countries.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#137

Post by dekhn »

conanbatt wrote: post #44
to11mtm wrote: post #42

Earlier quoted context omitted.

Also, I've never heard a good thing about Epic...

It's made in Visual Basic, and it literally cannot interact with its own versions. Hospitals have different versions of the same system in the same building and cant exchange information. All EMR's suck though. (note: I made one)

This is only my individual anecdote, but when I switched between two EPIC-using care providers (Kaiser->Anthem/Sutter), once I provided consent they pulled all my records over and 5 minutes later I was talking to a new doctor who had all the info from my previous doctor.

All EMRs suck though.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#138

Post by dekhn »

My wife used to work on an EMR that basically did the opposite of this - if a patient came in, and the dr was going to prescribe opiates, it would pop up a big window saying "Are you sure? There is potential for abuse..." for patients with a history of abuse (not sure what it did for other patients).

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#139

Post by pnw_hazor »

idiot900 wrote: post #14
pimmen wrote: post #4

I think this creates an interesting discussion on the part of the designers and programmers. Did they understand that what they were building was going to increase opioid dependence? Did they ask about it? And, the most interesting question of all: If they found out that was the case did they try to justify building it to themselves in some way? Full disclaimer: I have built software that I had ethical reservations a…

I'm a doctor. During medical school and residency, I was taught in good faith that "only as much as necessary" opioid was OK to give and wouldn't create dependence - it was only an "excess" of opioid that would cause a problem. So under the banner of reducing the suffering of our patients, and a mandate to reduce patient-reported pain scores, opioids flowed relatively freely. Now we know that was a terrible idea with…

US negligence law encourages physicians to follow "the medical standard of care." This means doing what they are taught in medical school shields MDs from liability until the standard of care changes. The law discourages MDs from deviating from "standard" practice because doing so removes the "standard of care" liability shield.

The software developers are not protected by the "standard of care" shield. The software developers, like just about every other profession are held to a higher standard than MDs, namely "ordinary care" or "reasonable care".

Is a software company taking reasonable care to avoid harm when it builds a software feature that secretly encourages doctors to issue dangerous prescriptions? I don't know -- doesn't sound like it to me. Though there are probably a few plaintiff's attorneys willing to find out how a jury thinks about it.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#140

Post by ohithereyou »

brianwawok wrote: post #116
aqme28 wrote: post #95

Earlier quoted context omitted.

More than that. This is unethical design. It's a design that probably killed people.

I think it's safe to remove probably. This went down a chain of people. CEO. VP. PM. Tech Lead. Developer. All of them made a choice to kill people for profit.

I've said this before on HN and I'll say it again.

Every C-level exec that was aware this happened and let it happen should be charged with a single count of involuntary manslaughter for every patient who had an opioid overdose that was prescribed pain medication by this system.

This is not acceptable, and people's heads should roll.

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