Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

bloomberg.com

Post reply on HN
Print view View original

251–260 of 269 posts

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

#251

Post by conanbatt »

nradov wrote: post #219
conanbatt wrote: post #191

Earlier quoted context omitted.

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.

Medicine is also a team sport now. Caring for patients with complex conditions requires coordination with multiple other practitioners. Exchanging paper records with them just isn't practical or safe. Plus if the doctor has to write a prescription, doing it on paper is so error prone as to border on malpractice.

I will be willing to say the opposite as well. Exchanging records is terrible. If you get records from say, Epic, you might get 300 pages.

Which doctor is going to read 300 pages of documentation for one if his 16 30-minute appointments a day?

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

#252

Post by [deleted] »

horsawlarway wrote: post #126
aqme28 wrote: post #95

Earlier quoted context omitted.

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

I'd argue it's actually MUCH worse than simply killing people (which is already pretty staggeringly bad). The constant push to privatize and let market forces drive medical interactions is CRUSHING trust in the system. Let's take an example patient, Sally. Sally goes to see her doctor, she's got some minor knee pain, but nothing serious. As a result of this profit motivated system, her doctor is likely to try to pres…

[deleted]

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

#253

Post by beaugunderson »

abdullahkhalids wrote: post #50
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…

I see people here who don't seem to get why this is unethical. So let's be crystal clear. Doctors are simply opening a patient's record, for whatever reason. This patient may not even be sick or need any medication. The doctor has to deal with a pop-up, and if they interact with it, they get presented with various options. Both options mentioned in the news report are likely to increase opioid addiction. The problem…

This is called Clinical Decision Support and there are many good implementations of it; the probably comes when you use a CDS framework to implement non-clinical decisions, e.g. to promote opioid prescriptions via a kickback deal as Practice Fusion did.

To see the list of CQMs that ONC certification requires (which are often used as inputs to CDS systems) you can look here: https://ecqi.healthit.gov/system/files/EP-EC-MeasuresTable-2...

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

#254

Post by beaugunderson »

sneak wrote: post #239
brianwawok wrote: post #116

Earlier quoted context omitted.

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 don’t think that’s an accurate statement, and is a misattribution of responsibility. The responsibility ultimately rests with the person who puts the drug in their own body. You can make an argument that their physician is in a position of trust, and that some responsibility lies with their prescribing it. Extending it out to the workers of the vendor is as silly as extending it out to the workers of the keyboard v…

Based on the court documentation in this case it's very accurate (CEO and directors on down are all implicated via emails); and I know via a friend that at least one team at Practice Fusion declined to build this feature.

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

#255

Post by beaugunderson »

mtgx wrote: post #59
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…

People are going to go to prison for this, right? Or has all white crime been made legal in America? Because I can't tell anymore.

There's a deferred prosecution agreement with a host of requirements; if PF follows them then no one goes to jail (which I find absurd, to be clear)

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

#256

Post by beaugunderson »

Jerry2 wrote: post #210

I was curious who the people behind Practice Fusion, the company in question, were so I did some digging: Executive team: https://web.archive.org/web/20131108114711/http://www.practi... Board of directors: https://web.archive.org/web/20131022222205/http://www.practi... They've removed all this information from their website. I wonder how these people can sleep at night knowing what kind of crimes against innocent peo…

That page looks to have been removed after Allscripts bought them. Part of the deferred prosecution agreement is that PF will have to have information about the prosecution on their website, so I'm looking forward to that.

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

#257

Post by conanbatt »

dekhn wrote: post #137
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)

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.

Yes, but that only works epic-to-epic. If you go to a non-epic place, epic will send you a 100 page PDF.

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

#258

Post by conanbatt »

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…

They've been a huge success for the wrong reasons. Its very much a rent-seeking driven business: vendor lock-in, big contracts with government money, etc. What they do would be considered anti-trust if it weren't that government paid them to do it.

You can build an ehr with google docs if it were legal. But it isn't.

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

#259

Post by conanbatt »

Ididntdothis wrote: post #242
slumdev wrote: post #235

Earlier quoted context omitted.

I think it's a matter of having the right tool for the job. If someone wanted to write a modern website in C++, I'd probably gripe about that. But Java, with either J2EE or Spring? No complaints here. VB just isn't appropriate anywhere anymore.

Every app has to start somewhere and will after a while be outdated. Whatever problems EPIC has are most likely not because of VB but because of bad management. I work in medical and I see almost every day management decisions that will lead to future software problems but nobody in leadership understands or wants to understand. Have a problem? Just throw the cheapest offshore team you can find at it. Repeat that a f…

This 'app' charges in the range of 6 digits yearly per provider.

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

#260

Post by Jamwinner »

kangaroozach wrote: post #229
pintxo wrote: post #11

Earlier quoted context omitted.

One doctors quote in the article says it all: > But, “if you want to model electronic health records as a for-profit system and not regulate them as such and force doctors to be on them, it’s almost inevitable that they’re going to be manipulated.”

If by manipulated he means continually improved through competitive pressure to on the whole deliver a better experience for less cost than the competition, then sure. All drugs are always on the table for doctors to choose from. It’s their responsibility to choose wisely and responsibly, even in the face of for profit nudges to behave a certain way.

Its pretty clear thats not what he means at all. He means manipulated by having unneeded highlu addictive drugs pushed on people who don't need them, many times destroyinh their lives in the process. That manipulation. Why are you being purposefully dense?
Post reply on HN