Opioids, kickbacks and EMRs

As the local health IT industry gears up for next week's HL7 International working group meeting in Sydney, the big news this week has come from the US, where the full details of the massive $US145 million fine levied against practice management system vendor Practice Fusion were revealed.

Practice Fusion, which first developed a PMS in 2008 and spruiked it to small, independent family doctor practices from its headquarters in San Francisco, gained substantial market share when it decided to offer the system for free. It quickly gathered investors and was a successful company, earning its revenue from advertising sales, predominantly from pharmaceutical companies. Practices were able to get an ad-free version by paying $100 a month, but few did.

Not surprisingly, it was rated by KLAS as the number one PMS for customer satisfaction and value in 2011, 2012 and 2013.

In 2014, however, the company decided to get even closer to its pharma pals and began to solicit kickbacks from them in exchange for adding alerts to the system's clinical decision support capabilities to encourage doctors to prescribe their medications. This included the solicitation of a payment of nearly $1 million from an opioid company to create a CDS alert that would encourage doctors to prescribe more extended release opioids.

It's stunning that anyone would do this, and stunning that they didn't think they'd get caught. It was announced last year that Practice Fusion would be fined $145 million for its behaviour, and the full details were released this week by the US Attorney’s Office for the District of Vermont. While it is the largest and first ever criminal action against an EMR vendor, it is slightly less than Massachusetts-based eClinicalWorks was fined in 2017, when it agreed to civil penalties of $155 million.

In that case, eClinicalWorks claimed erroneously that its software met the requirements of the US meaningful use legislation. Practice Fusion too ran afoul of certification requirements, which was what led the DOJ to begin investigating the company in the first place.

You might say spare a thought for Allscripts, which bought Practice Fusion in early 2018 for $100 million, less than the total fine it is now facing. However, Allscripts was offering $250 million just the year before and managed to knock down the price by agreeing to cover any cost resulting from the DOJ investigation.

Allscripts has since rebranded Practice Fusion as Veradigm, according to health IT trade magazine FierceHealthcare, which has been doing some stellar reporting on the saga for a number of years.

The other big news this week concerns another EMR giant in Epic, which is leading a charge against new rules suggested by the US Office of the National Coordinator for Health Information Technology to reduce information blocking and allow patients easier access to their information. Epic has raised privacy fears as a reason for opposing the rule, although rival vendor Cerner is all for it.

Epic argues that requiring health systems to release data to any third-party vendor specified by the patient could see that info being shared without the patient's knowledge. Epic founder Judy Faulkner has even written to the chief executives of some of her largest customers urging them to similarly oppose the rule.

This has raised the ire of patient advocates such as “ePatient Dave” DeBronkart, who calls the move “classic paternalism”, and led to 30 organisations signing a letter to the secretary of the Department of Health and Human Services to pass the rule post-haste. They say it will revolutionise interoperability as we know it.

Elsewhere, Microsoft launched a new initiative called AI for Health, putting up $40m over five years. That sum isn't a great deal for Microsoft but it does build on the company's investment in its Microsoft Healthcare division, set up two years ago. Apple also continued its focus on the healthcare sector when releasing its December quarter financials – $91 billion in revenue! – this week.

And speaking of record numbers, Amazon reported its fourth quarter financial this week as well, boasting revenue of $87.4 billion. Amazon's venture into the pharmacy sector was the subject of our poll last week, when we asked if Amazon Pharmacy would find a market in Australia. Most respondents though so: 81 per cent said yes, 19 per cent said no.

That brings us to our poll for this week: Should software vendors determine whether patients can exchange their clinical information?

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.

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