Nefarious and subtle

From last week's LA Times

The maker of [free] health-records software used by tens of thousands of doctors’ offices was in on a scheme to get doctors to prescribe opioids to patients. 

To doctors opening patients’ electronic records across the U.S., the alert would have looked innocuous enough. 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 software company called Practice Fusion, was paid by a major opioid manufacturer to design it in an effort to boost prescriptions for addictive pain pills — even though overdose deaths had almost tripled during the previous 15 years, creating a public-health disaster. The software was used by tens of thousands of doctors’ offices. 

Its existence was revealed this week thanks to a government investigation. Practice Fusion agreed to pay $145 million to resolve civil and criminal cases, according to documents filed in a federal court in Vermont. Practice Fusion admitted to the scheme. The opioid maker was not named, though the details of the government case closely match a public research partnership between Practice Fusion and Purdue Pharma Inc., which makes OxyContin. ... 

The Practice Fusion case shows a more subtle method of reaching drug consumers. Employees estimated internally that the drug company could add almost 3,000 patients and bolster opioid sales by as much as $11.3 million through the partnership. Under the contract, the drugmaker paid Practice Fusion almost $1 million. 

“The pharmaceutical industry was egregious in advancing and propelling the access of opioids to a wider and wider population,” said Bertha Madras, a professor at Harvard Medical School who served on the President’s Commission on Combating Drug Addiction and the Opioid Crisis. She described the Practice Fusion arrangement as “nefarious and subtle.” 

Big tech companies have large-scale plans to reinvent healthcare, promising to revolutionize areas such as electronic records, which are a crucial source of data about consumer health. But the Practice Fusion case shows how such plans can be exploited and even provide a new avenue for financial interests to influence treatment. 

The San Francisco company was founded in 2005 and became known for its unique model of providing free, ad-supported health-records software to independent doctors. The company says its cloud-based platform has grown to be used in roughly 30,000 practices. Groundwork for the deal between the companies began in 2013, according to the statement of facts agreed to by Practice Fusion under a deferred prosecution agreement. The idea was to get the opioid maker’s pain drugs to certain kinds of patients: ones who weren’t taking opioids or those being prescribed the company’s less profitable products. It also aimed to secure longer prescriptions, according to the court papers.