Health-records software pushed opioids to doctors in secret deal with drugmaker • Hacker News Board

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

#191

Post by conanbatt » Thu, Jan 30, 2020, 10:33 PM UTC

nradov wrote: post #109

JshWright wrote: post #85

Earlier quoted context omitted.

They're in a very different market from Practice Fusion though. There aren't many small/independent practices rolling out Epic deployments...

Small independent practices are a dying market anyway. Provider organizations are all consolidating in order to achieve economies of scale (especially for EHRs), provide comprehensive services to patients under one roof, and achieve greater pricing power when negotiating with payers. Plus most physicians prefer being employees; they just want to practice medicine without the additional administrative hassle of runnin…

Its true that running independently is getting more difficult, but that's not "on the market" but on the insidious regulations around insurance, malpractice law, etc.

A doctor can't open up an office and tend to patients with pen and paper anymore, and they have to pay thousands of dollars a month to systems that are truly terrible to be compliant.

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

#192

Post by skwb » Thu, Jan 30, 2020, 10:44 PM UTC

conanbatt wrote: post #191

nradov wrote: post #109

Earlier quoted context omitted.

Small independent practices are a dying market anyway. Provider organizations are all consolidating in order to achieve economies of scale (especially for EHRs), provide comprehensive services to patients under one roof, and achieve greater pricing power when negotiating with payers. Plus most physicians prefer being employees; they just want to practice medicine without the additional administrative hassle of runnin…

Its true that running independently is getting more difficult, but that's not "on the market" but on the insidious regulations around insurance, malpractice law, etc. A doctor can't open up an office and tend to patients with pen and paper anymore, and they have to pay thousands of dollars a month to systems that are truly terrible to be compliant.

*If they want to accept Medicare dollars (and usually private insurance just follows Medicare). I remembered some South Western (I want to say Arizona) specialty clinic that basically didn't accept insurance and had pen and paper charts still.

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

#193

Post by ErikAugust » Thu, Jan 30, 2020, 10:50 PM UTC

codeulike wrote: post #5

[when opening a patients records] a pop-up would appear, asking about a patient’s level of pain. Then, a drop-down menu would list treatments ranging from a referral to a pain specialist to a prescription for an opioid painkiller. Click a button, and the program would create a treatment plan. From 2016 to spring 2019, the alert went off about 230 million times. The tool existed thanks to a secret deal. Its maker, a s…

A drug ad pop up in a health record? Do we have any more "dystopian sci-fi ideas" in the Backlog we want to implement today?

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

#194

Post by joshpadnick » Thu, Jan 30, 2020, 11:08 PM UTC

I remember the shock about 10 years ago when I saw that PracticeFusion wholesale-copied the website design of Mint.com and then just customized it to their own business[0]. It struck me as boldly unethical, and 10 years later this opioid popup scheme rings the same.

Perhaps we as an industry should just refuse to participate when the company clearly prioritizes profits over doing the right thing, or in this case killing patients.

[0a] Mint in June 2010: https://web.archive.org/web/20100628142953/http://www.mint.c...

[0b] PracticeFusion in Feb 2010 (though rendering required Flash at the time): https://web.archive.org/web/20100228002944/http://www.practi...

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

#195

Post by JshWright » Thu, Jan 30, 2020, 11:14 PM UTC

vkou wrote: post #157

JshWright wrote: post #80

Earlier quoted context omitted.

The age old adage... If you're not paying for the product, you are the product...

And if you are paying for the product, you are usually the product, too. This adage is as useless as it is trite.

All the best adages are...

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

#196

Post by jessaustin » Thu, Jan 30, 2020, 11:46 PM UTC

...free, ad-supported health-records software to independent doctors...

You're not the customer...

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

#197

Post by fzeroracer » Thu, Jan 30, 2020, 11:48 PM UTC

codeulike wrote: post #5

[when opening a patients records] a pop-up would appear, asking about a patient’s level of pain. Then, a drop-down menu would list treatments ranging from a referral to a pain specialist to a prescription for an opioid painkiller. Click a button, and the program would create a treatment plan. From 2016 to spring 2019, the alert went off about 230 million times. The tool existed thanks to a secret deal. Its maker, a s…

This is a perfect example of how free markets fail when profiteering is not aligned with the user in mind.

Their sole purpose is to increase sales of their pain medication. The best way to do that is to advertise your drug to people who can push them, and even better if you can wear them down into making shitty decisions that involve them buying your drug.

The free market can't fix this problem because it's hidden (intentionally) and because what the company wants is not what the user wants. The only recourse is legislation.

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

#198

Post by jessaustin » Thu, Jan 30, 2020, 11:57 PM UTC

bpaddock wrote: post #41

idiot900 wrote: post #14

Earlier quoted context omitted.

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…

The problem is things have gone to far the other way now. Those with Chronic Pain are now committing suicide (as did my wife) when they are let to suffer. The CDC itself stated in April of 2019: "CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain Some policies, practices attributed to the Guideline are inconsistent with its recommendations" Sadly the medical community is not…

My condolences for your loss. My grandfather did the same, for the same reason.

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

#199

Post by jessaustin » Fri, Jan 31, 2020, 12:03 AM UTC

pnw_hazor wrote: post #139

idiot900 wrote: post #14

Earlier quoted context omitted.

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…

Going through medical school and years of post-doc training makes physicians less responsible than people with no medical knowledge whatsoever? Yikes! If this is true, I hope the AMA lobbyists who bribed that turd onto the books were paid well for their evil deeds...

It's probably also not great for patients with rare diseases, that physicians are penalized for trying to solve problems no physician has solved before.

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

#200

Post by jessaustin » Fri, Jan 31, 2020, 12:09 AM UTC

bryanrasmussen wrote: post #39

icoder wrote: post #29

Earlier quoted context omitted.

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.

Sure, not every developer who worked on the application needs to know what would cause the modal to appear and what possible messages it might have. But I think it likely that somewhere there was a developer who knew what that there was a query | logic function checking the patients pain relievers status etc. and a developer knowing that in the database the text came back with hey you should give this guy some oxy. A…

For complex business support software, are pop-up messages usually written by developers? What about the various translations of those messages? Don't these all just sit in .po files somewhere? This seems like more of an "analyst" task to me.