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

384 points by braythwayt 7y ago

alistairSH 7y ago
Another slap on the wrist for corporate malfeasance. And the executives who dream up and sign these deals get away with murder.
RobLach 7y ago
What horrid business. Embarrassing.
pimmen 7y ago
I think this creates an interesting discussion on the part of the designers and programmers. Did they understand that what they were building was going to increase opioid dependence? Did they ask about it? And, the most interesting question of all: If they found out that was the case did they try to justify building it to themselves in some way? Full disclaimer: I have built software that I had ethical reservations about myself. I am in no way a saint, I don't claim to know what I would've done in the same situation but I think it's for the benefit of software development to acknowledge that we do make ethical decisions when we build things and that the solution to something as complicated and diverse as ethics is not to just ignore it.
- nkrisc 7y ago
  To be fair to the developers and designers: how exactly would they know that the inclusion of "opioid prescription" as an item in that list would help fuel a an opioid epidemic? Hindsight is 20/20, but would you expect them at the time to think, "If we include this as an option in this list, it will contribute to a nationwide epidemic of opioid abuse and countless deaths"? Honestly, I think it's a stretch, especially if they weren't aware of a deal with opioid manufacturers being the reason for it in the first place. It would be one thing of some product manager came to them and said, "since a large opioid manufacturer has paid us a lot of money, we're going to implement this feature in order to increase unnecessary opioid prescriptions" but I would be surprised if that happened. "We're going to implement this feature to help doctors pick the right treatment for a patient's pain." Someone here is evil and deserves what's coming, but I don't know that it necessarily would have been readily obvious to those implementing it. In fact, it would likely have been preferable to conceal the true nature of it lest any of them have any moral qualms or objections. I'm not trying to negate your question, either. I think it's a good question to ask and consider.
  - mehlmao 7y ago
    This "feature" was added to the software in 2016, well into the epidemic.
  - ryandrake 7y ago
    I’ve never been a big fan of the “I don’t know what my software does—I just move JSON around” excuse. As professionals, we need to be aware of the intended use of the things we make, and that includes weighing the ethical implications. We also need a professional ethical vow with teeth like the Hippocratic Oath that allows tech professionals to push back against demands to write unethical software, but that’s a topic for another thread.
    - nkrisc 7y ago
      I don't disagree. But my point was that it's not always clear what the implications are. Sometimes it's more obvious, sometime it's not. We also don't know what the "intended" use of this feature that was presented to the people who made it was. They could very well have been deceived as to it's true nature. This could very easily have been presented and sold to a team in a way that does not make it immediately seem like something evil.
      - mcguire 7y ago
        The bottom line is that developers and designers are not professionals, who would have to accept responsibility for their products. It is in the best interests of developers and designers not to be professionals and not to accept responsibility in cases like this. A standard argument for this state of affairs is that it is in the best interest of society to allow developers and designers this freedom from responsibility, because of all the shiny new products. In which case you have to accept incidents like this---you can't make an omelette without breaking a few eggs.
  - jfarmer 7y ago
    > If we include this as an option in this list, it will contribute to a nationwide epidemic of opioid abuse and countless deaths? Give. me. a. break! At a minimum they should ask, "What are the potential downsides? How extreme are they? How can we determine how likely those potential downsides are?" I'd expect every junior PM to ask _that_ series of questions about any product decision in any market. There's a reason clinical trials have protocols for early termination. Not understanding that early termination is a thing when building a social app is one thing, but they're building EMR software!
- idiot900 7y ago
  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 devastating consequences. But we didn't know better and truly thought we were doing right by our patients. It's hard to imagine a programmer without medical training could be blamed.
  - pimmen 7y ago
    That would absolutely be a valid reason to build the service like that; the medical community thought that only an excess of opioids would be a problem, and it directly improves the numbers they're evaluated on. However, once the medical community gets wise to what an awful idea that was, I hope that when the software providers hear about this they try to figure out a way to mitigate the damage they're causing. This feature was added in 2016. Though, I think we agree that you cannot make an ethical decision on which action you should take unless you have any idea of what the consequences of your actions will be.
  - bpaddock 7y ago
    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 getting that message due to this mater now becoming political. https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html https://www.cdc.gov/media/releases/2019/s0424-advises-misapp...
    - conanbatt 7y ago
      Incredible that this is another comment of yours that manifests the answer I gave you in this topic. Providers are under the microscope for opioids now, so why risk it, it's not their pain. Medicine is a rough field.
codeulike 7y ago
[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 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 ... Its existence was revealed this week thanks to a government investigation. Holy shit
- pintxo 7y ago
  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.”
  - kangaroozach 7y ago
    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.
    - pintxo 7y ago
      You might not have realized it, but doctors are just mere humans like everyone else. As such they are not magically immune to outside influence. Also, I believe our interpretation of the quote differs quite a lot from mine. I read the original quote as: the doctors get manipulated. This reading seems to be incompatible with your response.
    - Jamwinner 7y ago
      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?
coldcode 7y ago
Yet all that happens is they pay a small fine and promise not to do it again. Tell that to all the families who lost people to opioids.
- chadmeister 7y ago
  :(
- deleted 7y ago
  [deleted]
- JshWright 7y ago
  According to the "statement of facts" the US Attorney's office released, this action resulted in "tens of thousands" of additional prescriptions of highly addictive extended release opioids. Without a doubt this resulted in lives and families destroyed. I'm not sure the fine is "small" though (not that any fine could be sufficient), Practice Fusion was acquired last year for "only" $100M.
  - toomuchtodo 7y ago
    Civil suits are a possibility. Someone bought a whole lot of liability.
    - raverbashing 7y ago
      Class action lawsuits are a money making machine for lawyers but it seems this is the use case they were designed for
- IanSanders 7y ago
  Here's one solution: in addition to charging a one-off fine, increase tax rates of responsible people/entities.
MandieD 7y ago
Story from VTDigger: https://vtdigger.org/2020/01/27/health-records-firm-agrees-to-145m-fine-the-largest-ever-in-vermont/ https://vtdigger.org/2020/01/27/health-records-firm-agrees-t... Spoiler alert: "Pharma Co. X" is Purdue. Shocking! /s
r_singh 7y ago
In retrospect doesn't seem like a very big surprise that they would resort to something like this as Practice Fusion was initially launched as free for a long time, and costed only $99 per month later. One should be increasingly wary of using free software for crucial applications and sensitive data. Being HIPAA compliant isn't enough. There's a regulatory body called POC3 (https://www.poc3.org https://www.poc3.org) for communication device (and software) providers who make money from pharmaceutical ads to lay down ethical guidelines. Hopefully a body like this should be formed for partnerships between pharmaceutical companies and EHR (& similar) software products too.
- swiley 7y ago
  I think you mean free as in free beer and software as in software services. IMO the medical industry could use more free as in freedom software, and that may be an alternative way to prevent things like this.
  - BlueTemplar 7y ago
    I prefer "libre". (Sorry, Indians, you'll have to learn some French...)
  - skwb 7y ago
    The healthcare industry is VERY conservative. Even the thought of moving EHR hosting to the cloud was a huge effort. Things in this industry are simply done at a different pace. Even digitization of medical records required millions of dollars in federal incentives (the carrot), and even more money at stake for not adopting (the stick).
  - inetknght 7y ago
    How would free as in freedom software prevent this from happening?
    - TeMPOraL 7y ago
      Somebody would've removed the bullshit popup and gave doctors that fixed version instead. Also, the culture around free software and the culture around such abuse doesn't intersect much.
imvetri 7y ago
https://www.reddit.com/r/technology/comments/evt5vz/electronic_patient_records_systems_used_by https://www.reddit.com/r/technology/comments/evt5vz/electron...
marriedWpt 7y ago
Remember when physicians said they should be the only ones to give out antibiotics for our safety? Can we totally kill that excuse for their monopoly? We trusted the physician cartel for decades and they have made healthcare worse.
- jacobush 7y ago
  Yeah... how about regulate them and then enforce it. Antibiotics should never be off the counter.
  - sambull 7y ago
    How do you feel about the uses of antibiotics in the food chain? The US of which is #1 winning in that.
    - jacobush 7y ago
      It's truly absurd, incredibly short-sighted even if one were to take the advantages at face value. But the advantages are a microcosm of horror, too, like the ability to keep animals clamped in extremely constricted, filthy, stress inducing environments without the flesh literally rotting off their bones, while feeding them a diet (corn for cattle?!) which gives them ulcers.
      - distances 7y ago
        The industrial farming practices are so disgusting I'm just lacking the words. Antibiotics should be a last resort, prescribed by a vet on a per-animal basis after other conditions are verified to be fine. There should be a clear financial incentive to keep farm animals healthy by default!
- bpaddock 7y ago
  Fluoroquinolone antibiotics such as Levaquin (no longer manufactured, only generics now [you can not sue the makers of generics in most states]), Cipro etc. should be removed from the market due to their devastating side effects. My late wife's Journal was part of the 2015 FDA hearing about getting these restricted from doctors giving them out like candy. Alas all we got was yet more "Black Box" warnings that you and the doctors never see. Karen ultimately killed herself from the Chronic Pain cause by the Levaquin and Cerebrospinal Leaks (CSF Leaks). Her saga is one of the five stories in the upcoming documentary Pain Warriors being released to distribution this spring. I'm now up to 44 people that have told me that their own CSF Leak started after taking Levaquin, Cipro etc. Something that there is ZERO medical research on. The Leak doctors are aware of this as I spoke about it at their first ever CSF Leak conference. Someone here will inevitably say "I took Cipro et.al just fine". Many people do take it may times until they have a reaction or they don't associate their new health problems with the delayed reaction months later. Antibiotics in general are a good thing, however we must never assume they are safe in and of themselves without consequences.
chadmeister 7y ago
This is one of the most comically evil things I've ever heard of. I bet you the person who designed this feature is on hacker news as we speak. If you are and you see this I hope you get run over by a bus today.
- loceng 7y ago
  I'd rather take a positive approach - and wish that the person would not be a coward and raise alarm bells, or that we had whistle blower laws and a substantial reward in place so whistle blowing was also incentivized.
- vsareto 7y ago
  Always good to throw the line developers under the bus and let the executives get away with it. I mean, as a developer, I'm always going business to business to pitch my dark-pattern UI features to companies and by gosh I just wish someone would stop me!
  - ethanbond 7y ago
    How about both are responsible?
    - vsareto 7y ago
      Correct, but some are more responsible than others
  - CoolGuySteve 7y ago
    Why shouldn’t you implicate the developer? If your manager asks you to implement something that can kill people you have a moral obligation to quit. Whoever implemented this is as much of a shitbag as the executive who asked for it.
    - icoder 7y ago
      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.
sjg007 7y ago
This was Practice Fusion, which was a startup in SV/SF. https://news.ycombinator.com/item?id=22165946&ref=hvper.com&utm_source=hvper.com&utm_medium=website https://news.ycombinator.com/item?id=22165946&ref=hvper.com&...
dirktheman 7y ago
If I would know that my MD is using a free, cloud based, ad-supported platform to keep my health records I'd be rather ticked off...
- conanbatt 7y ago
  You could ask your provider to use Epic, which is none of those and can cost upwards of 10k a year per doctor. Practice fusion is an industry leader precisely because it makes delivering care compliant and cheap for doctors. In any case, the user of EMR's are providers, not patients.
  - to11mtm 7y ago
    Also, I've never heard a good thing about Epic...
    - conanbatt 7y ago
      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)
      - Ididntdothis 7y ago
        ”It's made in Visual Basic” We shouldn’t feed the illusion that old stacks are inherently bad and that new stacks will magically solve all problems.
        slumdev 7y ago
        Nobody makes this complaint about C++ (which is older) or Java (which is almost as old.)
        Ididntdothis 7y ago
ptah 7y ago
surely this is jailable fraud?
ptah 7y ago
doesn't texas still have death penalty? pity it doesn't apply to corporations. both of them deserve it
- dylan604 7y ago
  "Capital punishment is a legal penalty in the United States, currently used by 29 states, the federal government, and the military" https://en.wikipedia.org/wiki/Capital_punishment_in_the_United_States https://en.wikipedia.org/wiki/Capital_punishment_in_the_Unit...
- Nasrudith 7y ago
  I don't think the crimes technically qualify as a capital crime despite the major and obvious ethical and moral lapses. Even with more blatant and callous examples like "miracle mineral solution" (read: bleach as medicine for internal use) fraudsters don't reach that level. Nor even "knowingly selling possibly tainted products". Not a lawyer but I think it essentially would call for say deliberately adding cyanide to your products to be outright murder.
conanbatt 7y ago
Designing the tools that providers use to treat patients is exceedingly difficult and filled with moral hazards. What makes this instance so pernicious is that it was involved in what is now a national crisis, but it's not very different to what a flu vaccination manufacturer could do, and which would raise no eyebrows in the eyes of the public or the government. Medicine is one of those fields where the discrepancy of what patients think it is and what it actually is is wide enough to cause outrage at every single thing.
- Wowfunhappy 7y ago
  > Designing the tools that providers use to treat patients is exceedingly difficult and filled with moral hazards. I don't doubt that—but I also have a lot of trouble believing that the people who designed this tool didn't know exactly what they were incentivizing. A UI designed with the user's interests in mind simply would not have come out this way. The degree to which we've normalized the creation of dark patterns is scary.
OnlyRepliesToBS 7y ago
a free market of lesser pain management therapies should be available to all consumers so no one would have to medicate with opioids
bitwize 7y ago
Candy Crush adverts in Windows 10 was bad enough, but this is next-level evil. Time for the software industry to wake up and realize it's not the advertising industry.
- m_fayer 7y ago
  Most software is streamlined automated bureaucracy. Not in the pejorative sense, but in the "basic infrastructure of a human enterprise" sense. Seen that way, it's absolutely criminal for software to allow the highest bidder to inject arbitrary bias into this infrastructure. On the other hand, it's absolutely foolish for organizations, which in the paper days hand-grew their infrastructure, to not closely scrutinize the nervous system/potential-trojan-horse that they're taking off the shelf and installing right into their core.
neonate 7y ago
http://archive.md/5HYTs http://archive.md/5HYTs
dfsegoat 7y ago
A murder trial for an MD who was over-prescribing opioids just started in my city [1]. How are the developers of this software not being criminally charged? It literally seems like the same thing and if nothing else, they made it easier for doctors to potentially kill people and face charges themselves. 1 - https://www.pressdemocrat.com/news/10643995-181/murder-trial-against-santa-rosa https://www.pressdemocrat.com/news/10643995-181/murder-trial...
- alexandercrohde 7y ago
  I think punishing the engineer would be much less practical than the CEO. There will always be an engineer (perhaps a remote contractor) who will build this.
  - mywittyname 7y ago
    Also, you can be involved in the development of such things and not really be aware of what's going on. Like, you could be the front-end developer that presents the options returned from an API, or the back-end developer that just returns options from the DB and maintains the CRUD site for people to assign treatment X for ailment Y. The person who ended up pushing opioids as a treatment for ∀y is very likely not an engineer.
  - dfsegoat 7y ago
    > I think punishing the engineer would be much less practical than the CEO. Of course. I wouldn't really ever consider engineers to be to blame - they could whistleblow of course, but the people that inked the deal and brought it to the engineers should be held responsible. If we can't hold the tech industry responsible for this, what hope do we have holding them responsible for murkier issues like privacy/data collection? edit: by "developers" in my parent post, I meant "the EHR company"
    - batiudrami 7y ago
      A fundamental part of engineering accreditation in most countries is ethics and enforcing the fact that you are to blame for the things you build and you are obligated to raise objection.
kingkawn 7y ago
Who’d a thought that drug dealing was so lucrative?
- lawn 7y ago
  There's a certain irony on how the U.S. has spent billions on the war on drugs, yet they still have a gigantic drug dealing problem, right under their nose.
  - WorldMaker 7y ago
    It's not that ironic when you realize that some of it is causal: restricting the supply of dealers makes the remaining dealers more bold (and gives them more incentive to pay lobbying costs to encourage the government to keep the supply restricted).
  - mywittyname 7y ago
    Irony is not the word I'd used. People are using their government influence to rob citizens blind for their self-enrichment. The war on drugs was used to enrich police forces and suppliers while the opioid problem was for the benefit of the pharmacy and insurance companies.
KoftaBob 7y ago
"Practice Fusion admitted to the scheme with an unnamed opioid maker, though the details of the government case closely match a public research partnership between Practice Fusion and Purdue Pharma Inc., which makes OxyContin." Color me surprised that it's probably Purdue. Every asset that the Sackler family owns should be seized.
- annoyingnoob 7y ago
  We really need to bring back the Stocks/Pillory for the Sacklers.
dkarras 7y ago
As a non-American I'm also curious about the mass necessity of opioid painkillers to begin with. From what I hear, people are prescribed opioids post surgery etc. which is bonkers to me as a foreigner. I'm a middle aged person and I have never seen anyone using opioid painkillers anywhere in my life. They give stuff to you when you are having surgery, and when you are in hospital's care, but something very extraordinary has to happen here to have access to those medications outside of a hospital setting. In the USA it seems to me like most people are prescribed these painkillers at least once in their life between 1-50 years but here, it is very exceptional and people are doing just fine.
- nradov 7y ago
  In 2007 an oral surgeon gave me a prescription for opioid painkillers after a wisdom tooth extraction, just in case I needed it for pain. The pain wasn't very bad and I never filled the prescription, but in retrospect giving me that prescription in the first place was just crazy! Another doctor gave my wife an opioid painkiller prescription upon hospital discharge after a normal childbirth, just in case she needed it. Also never filled or used. In the past few years doctors and pharmacists have become more aware of the risks and now write fewer opioid prescriptions. But for a while it was totally out of control. (I don't think either doctor was using Practice Fusion.)
  - somurzakov 7y ago
    this is to prevent you from going to the ER and getting an enormous bill. sometimes after tooth extraction a condition called "dry socket" can develop and it will cause enormous pain. opioids solve that until your next regular visit to a doctor. otherwise you could feel terrible pain and go to ER in the night with all the consequences https://en.wikipedia.org/wiki/Alveolar_osteitis https://en.wikipedia.org/wiki/Alveolar_osteitis
    - specialist 7y ago
      One should always have scripts both for pain killers and anti-nausea meds at the ready after major procedures. And avoid scheduling anything right before your surgeon takes time off (weekends, vacation).
LatteLazy 7y ago
Profit motive is great for simple products, ones that have few social implications, ones where defects or issues appear quickly. Maybe that used to be the case in medicine. But its not anymore.
logfromblammo 7y ago
They put pop-up stealth advertisements, targeted at your doctor, into your electronic medical record, so that he or she would get you addicted to painkillers. Software developers did this. For drug money. That's just terrible, isn't it? They shouldn't have done that. But even if the developers had ethical concerns, they had no recourse but to quit, and be replaced by someone else--who might get six months of work in before realizing that they are working for the baddies, and also deciding to either quit or die a little inside. I would do that job. I would take that money. I don't get a stupidly-inflated Valley salary with bonus RSUs, and I have bills to pay. I don't have a union that can protect me from nonsense. I know it's wrong. I would do it anyway, because I have been screwed by every company I have ever worked for, such that I learned that my ethics don't matter. Money matters. I want my kids to get an education without student loans, if they want it. I want to drive a car that isn't older than they are. And I want to retire before I die. My ethics would only keep me from that. Apparently, the companies that aren't managed by money-grubbing sociopaths just don't hire where I live. So if you don't want stuff like this to happen, make it actually mean something to have ethical objections, even for people working outside of California. I build software that has probably contributed in a material way to human suffering. For far less money than a Silicon Valley developer might get paid to make a mobile app for on-demand dog-walking. Everyone in my building does it. Everyone in the building across the street does it. Companies that don't hurt people as part of their business model aren't hiring here. People that have a problem with it--or at least those who can't hide that they do--don't get the jobs. So if you are currently on a high horse, I hope you enjoy the view from up there. You haven't yet used your influence to help other workers--those with nigh-nonexistent power as an individual to influence the corporate employers that reluctantly hire them, and then reserve the right to fire at any time for any reason, or no reason.
- vharuck 7y ago
  >But even if the developers had ethical concerns, they had no recourse but to quit, and be replaced by someone else I'm not saying that everyone who touched the software should be indicted, but there were options beyond quitting. They could've told the customers, the news outlets, or the government. Of course, when you're surrounded by people doing the same thing and nobody else is speaking up, it's not unreasonable to think you're the only one who sees it as shady.
concernedhit 7y ago
The physicians Rich Loomis (Practice Fusion CMO) & Steve Labkoff (Purdue Exec Med Director) who approved this horrific program have cushy corporate jobs elsewhere now & will never be prosecuted.
zouhair 7y ago
This is one of the reason some things should never be left to the market or be driven by profit. Healthcare is a clear example of that.
rolltiide 7y ago
the market will always gravitate towards products that scale, that's all drugs are. when you become more efficient it is intangible easily replicable things. I think a quadrant based graph makes this more apparent and can influence public policy
- jessaustin 7y ago
  Could you flesh this out a bit more? What are the two axes of the quadrant?
  - rolltiide 7y ago
    Liquidity, overhead Maybe a z-axis for margins
rayhendricks 7y ago
“ The San Francisco-based company was founded in 2005 and became known for its unique model of providing free, ad-supported health-records software to independent doctors.” I thought we have some of the most expensive doctors in the world, why can’t we get paid ehr software? The ceo responsible for this mess is Tom Langan. Why we are not able to put him in jail for a year is still a mystery. This is pure evil.
- Allower 7y ago
  Jail for a year??? How about the rest of his pathetic life, human beings with this level of depravity do not belong in our society, period.
dekhn 7y ago
My wife used to work on an EMR that basically did the opposite of this - if a patient came in, and the dr was going to prescribe opiates, it would pop up a big window saying "Are you sure? There is potential for abuse..." for patients with a history of abuse (not sure what it did for other patients).
Allower 7y ago
Bring back the gallows for this type of stuff. $143 million in fines is NOTHING, its literally encouraging this type of behavior. Utterly despicable.
fkfaduc 7y ago
I'll definitely put that on my list of arguments against proprietary software (although I'm aware that's not the primary issue).
joshpadnick 7y ago
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.com/ 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.practicefusion.com/ https://web.archive.org/web/20100228002944/http://www.practi...
thoughtstheseus 7y ago
Wow, less than 50 years of internet and already people are designing software to manipulate doctors into recommending opioids. Just think what might happen with younger peoples.
Jerry2 7y ago
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.practicefusion.com/pages/executive_team.html https://web.archive.org/web/20131108114711/http://www.practi... Board of directors: https://web.archive.org/web/20131022222205/http://www.practicefusion.com/pages/advisory_board.html 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 people they've (allegedly) committed.
- beaugunderson 7y ago
  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.
Barrin92 7y ago
Enough people have pointed to the problems of for-profit healthcare and drug markets in the comments but I'd also want to stress that this is also an issue of privacy. These patient informations should never have made it through so many hands and there should be no pop-up ads in a doctors record file. Before anyone complains about burdensome regulations, these are the situations were respecting people's information prevents deaths an family tragedy.
jessaustin 7y ago
...free, ad-supported health-records software to independent doctors... You're not the customer...
say_it_as_it_is 7y ago
If a doctor is unable to think independently of a pop-up recommendation for a drug, the doctor should have his/her license taken away. This should be the next step in the process for real social justice.
Amarok 7y ago
I believe opioid addiction is not well understood among general practitioners. Here in the UK, they accept as common sense that your patient won't get addicted if they're taking opioids for pain. Similarly for ADHD, when I was started on meds my psychiatrist reassured there was no risk of addiction because I had ADHD. In practice, whenever I spend more than 3 days without them I get terrible headaches.
Jamwinner 7y ago
The people defending these types of actions here make me sick. What the hell.

384 points by braythwayt 7y ago

Another slap on the wrist for corporate malfeasance. And the executives who dream up and sign these deals get away with murder.

RobLach 7y ago

What horrid business. Embarrassing.

pimmen 7y ago

I think this creates an interesting discussion on the part of the designers and programmers. Did they understand that what they were building was going to increase opioid dependence? Did they ask about it? And, the most interesting question of all: If they found out that was the case did they try to justify building it to themselves in some way? Full disclaimer: I have built software that I had ethical reservations about myself. I am in no way a saint, I don't claim to know what I would've done in the same situation but I think it's for the benefit of software development to acknowledge that we do make ethical decisions when we build things and that the solution to something as complicated and diverse as ethics is not to just ignore it.

nkrisc 7y ago
To be fair to the developers and designers: how exactly would they know that the inclusion of "opioid prescription" as an item in that list would help fuel a an opioid epidemic? Hindsight is 20/20, but would you expect them at the time to think, "If we include this as an option in this list, it will contribute to a nationwide epidemic of opioid abuse and countless deaths"? Honestly, I think it's a stretch, especially if they weren't aware of a deal with opioid manufacturers being the reason for it in the first place. It would be one thing of some product manager came to them and said, "since a large opioid manufacturer has paid us a lot of money, we're going to implement this feature in order to increase unnecessary opioid prescriptions" but I would be surprised if that happened. "We're going to implement this feature to help doctors pick the right treatment for a patient's pain." Someone here is evil and deserves what's coming, but I don't know that it necessarily would have been readily obvious to those implementing it. In fact, it would likely have been preferable to conceal the true nature of it lest any of them have any moral qualms or objections. I'm not trying to negate your question, either. I think it's a good question to ask and consider.
- mehlmao 7y ago
  This "feature" was added to the software in 2016, well into the epidemic.
- ryandrake 7y ago
  I’ve never been a big fan of the “I don’t know what my software does—I just move JSON around” excuse. As professionals, we need to be aware of the intended use of the things we make, and that includes weighing the ethical implications. We also need a professional ethical vow with teeth like the Hippocratic Oath that allows tech professionals to push back against demands to write unethical software, but that’s a topic for another thread.
  - nkrisc 7y ago
    I don't disagree. But my point was that it's not always clear what the implications are. Sometimes it's more obvious, sometime it's not. We also don't know what the "intended" use of this feature that was presented to the people who made it was. They could very well have been deceived as to it's true nature. This could very easily have been presented and sold to a team in a way that does not make it immediately seem like something evil.
    - mcguire 7y ago
      The bottom line is that developers and designers are not professionals, who would have to accept responsibility for their products. It is in the best interests of developers and designers not to be professionals and not to accept responsibility in cases like this. A standard argument for this state of affairs is that it is in the best interest of society to allow developers and designers this freedom from responsibility, because of all the shiny new products. In which case you have to accept incidents like this---you can't make an omelette without breaking a few eggs.
- jfarmer 7y ago
  > If we include this as an option in this list, it will contribute to a nationwide epidemic of opioid abuse and countless deaths? Give. me. a. break! At a minimum they should ask, "What are the potential downsides? How extreme are they? How can we determine how likely those potential downsides are?" I'd expect every junior PM to ask _that_ series of questions about any product decision in any market. There's a reason clinical trials have protocols for early termination. Not understanding that early termination is a thing when building a social app is one thing, but they're building EMR software!
idiot900 7y ago
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 devastating consequences. But we didn't know better and truly thought we were doing right by our patients. It's hard to imagine a programmer without medical training could be blamed.
- pimmen 7y ago
  That would absolutely be a valid reason to build the service like that; the medical community thought that only an excess of opioids would be a problem, and it directly improves the numbers they're evaluated on. However, once the medical community gets wise to what an awful idea that was, I hope that when the software providers hear about this they try to figure out a way to mitigate the damage they're causing. This feature was added in 2016. Though, I think we agree that you cannot make an ethical decision on which action you should take unless you have any idea of what the consequences of your actions will be.
- bpaddock 7y ago
  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 getting that message due to this mater now becoming political. https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html https://www.cdc.gov/media/releases/2019/s0424-advises-misapp...
  - conanbatt 7y ago
    Incredible that this is another comment of yours that manifests the answer I gave you in this topic. Providers are under the microscope for opioids now, so why risk it, it's not their pain. Medicine is a rough field.

codeulike 7y ago

[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 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 ... Its existence was revealed this week thanks to a government investigation. Holy shit

pintxo 7y ago
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.”
- kangaroozach 7y ago
  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.
  - pintxo 7y ago
    You might not have realized it, but doctors are just mere humans like everyone else. As such they are not magically immune to outside influence. Also, I believe our interpretation of the quote differs quite a lot from mine. I read the original quote as: the doctors get manipulated. This reading seems to be incompatible with your response.
  - Jamwinner 7y ago
    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?

coldcode 7y ago

Yet all that happens is they pay a small fine and promise not to do it again. Tell that to all the families who lost people to opioids.

chadmeister 7y ago
:(
deleted 7y ago
[deleted]
JshWright 7y ago
According to the "statement of facts" the US Attorney's office released, this action resulted in "tens of thousands" of additional prescriptions of highly addictive extended release opioids. Without a doubt this resulted in lives and families destroyed. I'm not sure the fine is "small" though (not that any fine could be sufficient), Practice Fusion was acquired last year for "only" $100M.
- toomuchtodo 7y ago
  Civil suits are a possibility. Someone bought a whole lot of liability.
  - raverbashing 7y ago
    Class action lawsuits are a money making machine for lawyers but it seems this is the use case they were designed for
IanSanders 7y ago
Here's one solution: in addition to charging a one-off fine, increase tax rates of responsible people/entities.

MandieD 7y ago

Story from VTDigger: https://vtdigger.org/2020/01/27/health-records-firm-agrees-to-145m-fine-the-largest-ever-in-vermont/ https://vtdigger.org/2020/01/27/health-records-firm-agrees-t... Spoiler alert: "Pharma Co. X" is Purdue. Shocking! /s

r_singh 7y ago

In retrospect doesn't seem like a very big surprise that they would resort to something like this as Practice Fusion was initially launched as free for a long time, and costed only $99 per month later. One should be increasingly wary of using free software for crucial applications and sensitive data. Being HIPAA compliant isn't enough. There's a regulatory body called POC3 (https://www.poc3.org https://www.poc3.org) for communication device (and software) providers who make money from pharmaceutical ads to lay down ethical guidelines. Hopefully a body like this should be formed for partnerships between pharmaceutical companies and EHR (& similar) software products too.

swiley 7y ago
I think you mean free as in free beer and software as in software services. IMO the medical industry could use more free as in freedom software, and that may be an alternative way to prevent things like this.
- BlueTemplar 7y ago
  I prefer "libre". (Sorry, Indians, you'll have to learn some French...)
- skwb 7y ago
  The healthcare industry is VERY conservative. Even the thought of moving EHR hosting to the cloud was a huge effort. Things in this industry are simply done at a different pace. Even digitization of medical records required millions of dollars in federal incentives (the carrot), and even more money at stake for not adopting (the stick).
- inetknght 7y ago
  How would free as in freedom software prevent this from happening?
  - TeMPOraL 7y ago
    Somebody would've removed the bullshit popup and gave doctors that fixed version instead. Also, the culture around free software and the culture around such abuse doesn't intersect much.

imvetri 7y ago

https://www.reddit.com/r/technology/comments/evt5vz/electronic_patient_records_systems_used_by https://www.reddit.com/r/technology/comments/evt5vz/electron...

marriedWpt 7y ago

Remember when physicians said they should be the only ones to give out antibiotics for our safety? Can we totally kill that excuse for their monopoly? We trusted the physician cartel for decades and they have made healthcare worse.

jacobush 7y ago
Yeah... how about regulate them and then enforce it. Antibiotics should never be off the counter.
- sambull 7y ago
  How do you feel about the uses of antibiotics in the food chain? The US of which is #1 winning in that.
  - jacobush 7y ago
    It's truly absurd, incredibly short-sighted even if one were to take the advantages at face value. But the advantages are a microcosm of horror, too, like the ability to keep animals clamped in extremely constricted, filthy, stress inducing environments without the flesh literally rotting off their bones, while feeding them a diet (corn for cattle?!) which gives them ulcers.
    - distances 7y ago
      The industrial farming practices are so disgusting I'm just lacking the words. Antibiotics should be a last resort, prescribed by a vet on a per-animal basis after other conditions are verified to be fine. There should be a clear financial incentive to keep farm animals healthy by default!
bpaddock 7y ago
Fluoroquinolone antibiotics such as Levaquin (no longer manufactured, only generics now [you can not sue the makers of generics in most states]), Cipro etc. should be removed from the market due to their devastating side effects. My late wife's Journal was part of the 2015 FDA hearing about getting these restricted from doctors giving them out like candy. Alas all we got was yet more "Black Box" warnings that you and the doctors never see. Karen ultimately killed herself from the Chronic Pain cause by the Levaquin and Cerebrospinal Leaks (CSF Leaks). Her saga is one of the five stories in the upcoming documentary Pain Warriors being released to distribution this spring. I'm now up to 44 people that have told me that their own CSF Leak started after taking Levaquin, Cipro etc. Something that there is ZERO medical research on. The Leak doctors are aware of this as I spoke about it at their first ever CSF Leak conference. Someone here will inevitably say "I took Cipro et.al just fine". Many people do take it may times until they have a reaction or they don't associate their new health problems with the delayed reaction months later. Antibiotics in general are a good thing, however we must never assume they are safe in and of themselves without consequences.

chadmeister 7y ago

This is one of the most comically evil things I've ever heard of. I bet you the person who designed this feature is on hacker news as we speak. If you are and you see this I hope you get run over by a bus today.

loceng 7y ago
I'd rather take a positive approach - and wish that the person would not be a coward and raise alarm bells, or that we had whistle blower laws and a substantial reward in place so whistle blowing was also incentivized.
vsareto 7y ago
Always good to throw the line developers under the bus and let the executives get away with it. I mean, as a developer, I'm always going business to business to pitch my dark-pattern UI features to companies and by gosh I just wish someone would stop me!
- ethanbond 7y ago
  How about both are responsible?
  - vsareto 7y ago
    Correct, but some are more responsible than others
- CoolGuySteve 7y ago
  Why shouldn’t you implicate the developer? If your manager asks you to implement something that can kill people you have a moral obligation to quit. Whoever implemented this is as much of a shitbag as the executive who asked for it.
  - icoder 7y ago
    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.

sjg007 7y ago

This was Practice Fusion, which was a startup in SV/SF. https://news.ycombinator.com/item?id=22165946&ref=hvper.com&utm_source=hvper.com&utm_medium=website https://news.ycombinator.com/item?id=22165946&ref=hvper.com&...

dirktheman 7y ago

If I would know that my MD is using a free, cloud based, ad-supported platform to keep my health records I'd be rather ticked off...

conanbatt 7y ago
You could ask your provider to use Epic, which is none of those and can cost upwards of 10k a year per doctor. Practice fusion is an industry leader precisely because it makes delivering care compliant and cheap for doctors. In any case, the user of EMR's are providers, not patients.
- to11mtm 7y ago
  Also, I've never heard a good thing about Epic...
  - conanbatt 7y ago
    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)
    - Ididntdothis 7y ago
      ”It's made in Visual Basic” We shouldn’t feed the illusion that old stacks are inherently bad and that new stacks will magically solve all problems.
      - slumdev 7y ago
        Nobody makes this complaint about C++ (which is older) or Java (which is almost as old.)
        Ididntdothis 7y ago

ptah 7y ago

surely this is jailable fraud?

ptah 7y ago

doesn't texas still have death penalty? pity it doesn't apply to corporations. both of them deserve it

dylan604 7y ago
"Capital punishment is a legal penalty in the United States, currently used by 29 states, the federal government, and the military" https://en.wikipedia.org/wiki/Capital_punishment_in_the_United_States https://en.wikipedia.org/wiki/Capital_punishment_in_the_Unit...
Nasrudith 7y ago
I don't think the crimes technically qualify as a capital crime despite the major and obvious ethical and moral lapses. Even with more blatant and callous examples like "miracle mineral solution" (read: bleach as medicine for internal use) fraudsters don't reach that level. Nor even "knowingly selling possibly tainted products". Not a lawyer but I think it essentially would call for say deliberately adding cyanide to your products to be outright murder.

conanbatt 7y ago

Designing the tools that providers use to treat patients is exceedingly difficult and filled with moral hazards. What makes this instance so pernicious is that it was involved in what is now a national crisis, but it's not very different to what a flu vaccination manufacturer could do, and which would raise no eyebrows in the eyes of the public or the government. Medicine is one of those fields where the discrepancy of what patients think it is and what it actually is is wide enough to cause outrage at every single thing.

Wowfunhappy 7y ago
> Designing the tools that providers use to treat patients is exceedingly difficult and filled with moral hazards. I don't doubt that—but I also have a lot of trouble believing that the people who designed this tool didn't know exactly what they were incentivizing. A UI designed with the user's interests in mind simply would not have come out this way. The degree to which we've normalized the creation of dark patterns is scary.

OnlyRepliesToBS 7y ago

a free market of lesser pain management therapies should be available to all consumers so no one would have to medicate with opioids

bitwize 7y ago

Candy Crush adverts in Windows 10 was bad enough, but this is next-level evil. Time for the software industry to wake up and realize it's not the advertising industry.

m_fayer 7y ago
Most software is streamlined automated bureaucracy. Not in the pejorative sense, but in the "basic infrastructure of a human enterprise" sense. Seen that way, it's absolutely criminal for software to allow the highest bidder to inject arbitrary bias into this infrastructure. On the other hand, it's absolutely foolish for organizations, which in the paper days hand-grew their infrastructure, to not closely scrutinize the nervous system/potential-trojan-horse that they're taking off the shelf and installing right into their core.

neonate 7y ago

http://archive.md/5HYTs http://archive.md/5HYTs

dfsegoat 7y ago

A murder trial for an MD who was over-prescribing opioids just started in my city [1]. How are the developers of this software not being criminally charged? It literally seems like the same thing and if nothing else, they made it easier for doctors to potentially kill people and face charges themselves. 1 - https://www.pressdemocrat.com/news/10643995-181/murder-trial-against-santa-rosa https://www.pressdemocrat.com/news/10643995-181/murder-trial...

alexandercrohde 7y ago
I think punishing the engineer would be much less practical than the CEO. There will always be an engineer (perhaps a remote contractor) who will build this.
- mywittyname 7y ago
  Also, you can be involved in the development of such things and not really be aware of what's going on. Like, you could be the front-end developer that presents the options returned from an API, or the back-end developer that just returns options from the DB and maintains the CRUD site for people to assign treatment X for ailment Y. The person who ended up pushing opioids as a treatment for ∀y is very likely not an engineer.
- dfsegoat 7y ago
  > I think punishing the engineer would be much less practical than the CEO. Of course. I wouldn't really ever consider engineers to be to blame - they could whistleblow of course, but the people that inked the deal and brought it to the engineers should be held responsible. If we can't hold the tech industry responsible for this, what hope do we have holding them responsible for murkier issues like privacy/data collection? edit: by "developers" in my parent post, I meant "the EHR company"
  - batiudrami 7y ago
    A fundamental part of engineering accreditation in most countries is ethics and enforcing the fact that you are to blame for the things you build and you are obligated to raise objection.

kingkawn 7y ago

Who’d a thought that drug dealing was so lucrative?

lawn 7y ago
There's a certain irony on how the U.S. has spent billions on the war on drugs, yet they still have a gigantic drug dealing problem, right under their nose.
- WorldMaker 7y ago
  It's not that ironic when you realize that some of it is causal: restricting the supply of dealers makes the remaining dealers more bold (and gives them more incentive to pay lobbying costs to encourage the government to keep the supply restricted).
- mywittyname 7y ago
  Irony is not the word I'd used. People are using their government influence to rob citizens blind for their self-enrichment. The war on drugs was used to enrich police forces and suppliers while the opioid problem was for the benefit of the pharmacy and insurance companies.

KoftaBob 7y ago

"Practice Fusion admitted to the scheme with an unnamed opioid maker, though the details of the government case closely match a public research partnership between Practice Fusion and Purdue Pharma Inc., which makes OxyContin." Color me surprised that it's probably Purdue. Every asset that the Sackler family owns should be seized.

annoyingnoob 7y ago
We really need to bring back the Stocks/Pillory for the Sacklers.

dkarras 7y ago

As a non-American I'm also curious about the mass necessity of opioid painkillers to begin with. From what I hear, people are prescribed opioids post surgery etc. which is bonkers to me as a foreigner. I'm a middle aged person and I have never seen anyone using opioid painkillers anywhere in my life. They give stuff to you when you are having surgery, and when you are in hospital's care, but something very extraordinary has to happen here to have access to those medications outside of a hospital setting. In the USA it seems to me like most people are prescribed these painkillers at least once in their life between 1-50 years but here, it is very exceptional and people are doing just fine.

nradov 7y ago
In 2007 an oral surgeon gave me a prescription for opioid painkillers after a wisdom tooth extraction, just in case I needed it for pain. The pain wasn't very bad and I never filled the prescription, but in retrospect giving me that prescription in the first place was just crazy! Another doctor gave my wife an opioid painkiller prescription upon hospital discharge after a normal childbirth, just in case she needed it. Also never filled or used. In the past few years doctors and pharmacists have become more aware of the risks and now write fewer opioid prescriptions. But for a while it was totally out of control. (I don't think either doctor was using Practice Fusion.)
- somurzakov 7y ago
  this is to prevent you from going to the ER and getting an enormous bill. sometimes after tooth extraction a condition called "dry socket" can develop and it will cause enormous pain. opioids solve that until your next regular visit to a doctor. otherwise you could feel terrible pain and go to ER in the night with all the consequences https://en.wikipedia.org/wiki/Alveolar_osteitis https://en.wikipedia.org/wiki/Alveolar_osteitis
  - specialist 7y ago
    One should always have scripts both for pain killers and anti-nausea meds at the ready after major procedures. And avoid scheduling anything right before your surgeon takes time off (weekends, vacation).

LatteLazy 7y ago

Profit motive is great for simple products, ones that have few social implications, ones where defects or issues appear quickly. Maybe that used to be the case in medicine. But its not anymore.

logfromblammo 7y ago

They put pop-up stealth advertisements, targeted at your doctor, into your electronic medical record, so that he or she would get you addicted to painkillers. Software developers did this. For drug money. That's just terrible, isn't it? They shouldn't have done that. But even if the developers had ethical concerns, they had no recourse but to quit, and be replaced by someone else--who might get six months of work in before realizing that they are working for the baddies, and also deciding to either quit or die a little inside. I would do that job. I would take that money. I don't get a stupidly-inflated Valley salary with bonus RSUs, and I have bills to pay. I don't have a union that can protect me from nonsense. I know it's wrong. I would do it anyway, because I have been screwed by every company I have ever worked for, such that I learned that my ethics don't matter. Money matters. I want my kids to get an education without student loans, if they want it. I want to drive a car that isn't older than they are. And I want to retire before I die. My ethics would only keep me from that. Apparently, the companies that aren't managed by money-grubbing sociopaths just don't hire where I live. So if you don't want stuff like this to happen, make it actually mean something to have ethical objections, even for people working outside of California. I build software that has probably contributed in a material way to human suffering. For far less money than a Silicon Valley developer might get paid to make a mobile app for on-demand dog-walking. Everyone in my building does it. Everyone in the building across the street does it. Companies that don't hurt people as part of their business model aren't hiring here. People that have a problem with it--or at least those who can't hide that they do--don't get the jobs. So if you are currently on a high horse, I hope you enjoy the view from up there. You haven't yet used your influence to help other workers--those with nigh-nonexistent power as an individual to influence the corporate employers that reluctantly hire them, and then reserve the right to fire at any time for any reason, or no reason.

vharuck 7y ago
>But even if the developers had ethical concerns, they had no recourse but to quit, and be replaced by someone else I'm not saying that everyone who touched the software should be indicted, but there were options beyond quitting. They could've told the customers, the news outlets, or the government. Of course, when you're surrounded by people doing the same thing and nobody else is speaking up, it's not unreasonable to think you're the only one who sees it as shady.

concernedhit 7y ago

The physicians Rich Loomis (Practice Fusion CMO) & Steve Labkoff (Purdue Exec Med Director) who approved this horrific program have cushy corporate jobs elsewhere now & will never be prosecuted.

zouhair 7y ago

This is one of the reason some things should never be left to the market or be driven by profit. Healthcare is a clear example of that.

rolltiide 7y ago

the market will always gravitate towards products that scale, that's all drugs are. when you become more efficient it is intangible easily replicable things. I think a quadrant based graph makes this more apparent and can influence public policy

jessaustin 7y ago
Could you flesh this out a bit more? What are the two axes of the quadrant?
- rolltiide 7y ago
  Liquidity, overhead Maybe a z-axis for margins

rayhendricks 7y ago

“ The San Francisco-based company was founded in 2005 and became known for its unique model of providing free, ad-supported health-records software to independent doctors.” I thought we have some of the most expensive doctors in the world, why can’t we get paid ehr software? The ceo responsible for this mess is Tom Langan. Why we are not able to put him in jail for a year is still a mystery. This is pure evil.

Allower 7y ago
Jail for a year??? How about the rest of his pathetic life, human beings with this level of depravity do not belong in our society, period.

dekhn 7y ago

My wife used to work on an EMR that basically did the opposite of this - if a patient came in, and the dr was going to prescribe opiates, it would pop up a big window saying "Are you sure? There is potential for abuse..." for patients with a history of abuse (not sure what it did for other patients).

Allower 7y ago

Bring back the gallows for this type of stuff. $143 million in fines is NOTHING, its literally encouraging this type of behavior. Utterly despicable.

fkfaduc 7y ago

I'll definitely put that on my list of arguments against proprietary software (although I'm aware that's not the primary issue).

joshpadnick 7y ago

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.com/ 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.practicefusion.com/ https://web.archive.org/web/20100228002944/http://www.practi...

thoughtstheseus 7y ago

Wow, less than 50 years of internet and already people are designing software to manipulate doctors into recommending opioids. Just think what might happen with younger peoples.

Jerry2 7y ago

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.practicefusion.com/pages/executive_team.html https://web.archive.org/web/20131108114711/http://www.practi... Board of directors: https://web.archive.org/web/20131022222205/http://www.practicefusion.com/pages/advisory_board.html 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 people they've (allegedly) committed.

beaugunderson 7y ago
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.

Barrin92 7y ago

Enough people have pointed to the problems of for-profit healthcare and drug markets in the comments but I'd also want to stress that this is also an issue of privacy. These patient informations should never have made it through so many hands and there should be no pop-up ads in a doctors record file. Before anyone complains about burdensome regulations, these are the situations were respecting people's information prevents deaths an family tragedy.

jessaustin 7y ago

...free, ad-supported health-records software to independent doctors... You're not the customer...

say_it_as_it_is 7y ago

If a doctor is unable to think independently of a pop-up recommendation for a drug, the doctor should have his/her license taken away. This should be the next step in the process for real social justice.

Amarok 7y ago

I believe opioid addiction is not well understood among general practitioners. Here in the UK, they accept as common sense that your patient won't get addicted if they're taking opioids for pain. Similarly for ADHD, when I was started on meds my psychiatrist reassured there was no risk of addiction because I had ADHD. In practice, whenever I spend more than 3 days without them I get terrible headaches.

Jamwinner 7y ago

The people defending these types of actions here make me sick. What the hell.