Thursday, January 24, 2013

Using the Medical Record to Advertise Drugs to Doctors: Thank the Cloud

At various times in the past I've taken a break from discussing medicine and Pharma to talk a little about health information technology and the electronic record, another area where commercial influence seems to be corrupting good medicine and the public's health (most recently:)
Today however I can talk about information technology with no apologies about deviating from the major theme of this blog. As Pamela Dolan writes in American Medical News:
--some makers of electronic medical records for doctors' offices are exploring how to embed drug ads in the record, in such a way that when the doctor is seeing a patient with a certain disease, an ad for a drug for that disease pops up at just the strategic moment.

To do this the record must be "cloud" based (I am still too much of a Luddite to feel sure that I know what "cloud" means in this context)-- a record that's based on a hard drive in the office cannot do the work required to select the right ads at the right time. The attraction for docs is that if the HIT company is making big bucks off selling ads, they can offer the record to the doc at a deeply discounted rate. Since electronic records are very expensive as an up-front cost--and as the promised back-end savings from the supposedly more efficient records have generally not materialized--this is a big deal for an office practice.  One of the scariest aspects of the article from the standpoint of medical professionalism is that one company, Practice Fusion, offers docs a choice. They can pay a monthly fee to get an ad-free electronic record; or they can get a free or much cheaper version with the ads. Only 1% of docs cough up the money to buy the ad-free version.

The article also makes clear that this is one element of what happened to Pharma with their 2009 "code of conduct" in which they agreed to give up a lot of the old-fashioned freebies for docs like the once-ubiquitous drug pens. I have yet to read a scholarly study of drug advertising expenditures to see if marketing costs actually went down at all but I would guess they didn't as the industry simply refocused its spending on new areas, the Internet being a high priority. And the electronic record is obnviously a very attractive portion of the Internet for drug firms.

The whole matter of electronic records (and the medical record more generally as some of this has little to do with whether it's electronic or paper) needs a lot more discussion to investigate the gradual erosion of this important aspect of professionalism in medicine, the historic concern for the record as ideally a tool of patient care. Physicians have been bought off by promises of higher reimbursements and have gradually allowed the record to become a tool for every imaginable administrative and bureaucratic function, to the point where one has to sort through pages and pages of idiocy in order to find one thing that tells you what's going on with a sick person. These data-loaded but real-information-poor records have become a positive threat to the patient's health instead of a tool for better quality care. To tell us now that by the way, they are going to be a vehicle for drug ads too, is the last straw--and a group of independent merchant-contractors who allow this to happen no longer deserve the title of "professionals."

(Hat tip to my esteemed colleague Dr. Scott Monteith for suggesting the Dolan article.)


InformaticsMD said...

A few years back I'd written a paper "A Medical Informatics Grand Challenge: the EMR and Post-Marketing Drug Surveillance" ( the informatics specialists found non-publshable; I'd presented some of the ideas in the paper to Merck officials in the adverse events & drug surveillance section of MRL. (I'd worked at Merck several years prior).

I was trying to get pharma interested in substantive uses of EHR.

Little did I know the EHR vendors and pharma would come up with scientifically frivolous uses such as advertisements, "Microsoft Office Starter" style.

By the way, the "cloud" is a buzzword signifying you've stored your data on some outside service's server farm, via the Internet usually, to save the costs of storing/maintaining it locally; and have complete confidence in their ability to be excellent stewards of the information, keeping it safe and secure.

This has the HIT hyperenthusiasts on "Cloud 9."

My rule of thumb is - never outsource functions absolutely crucial to your affairs, because sooner or later, you'll regret it.

But what do I know?

-- SS

Anonymous said...

i imagine this is why athenahealth bought epocrates recently.

Judy B said...

This is really chilling when you think about the possibilities for major invasion of patient privacy! It is another reason that I avoid the medical industry unless there is no other choice. How very sad to see what once was a noble profession corrupted....