Purdue pushed opioid sales with Patient Fusion.
A program called Practice Fusion was long used by doctors to access patients records electronically. A pop-up menu would ask about a patient’s level of pain which would include a drop-down menu listing treatment options. Among the options listed were treatment by a pain specialist and opioid pain pills. What the physicians didn’t know was the tool was created as part of a secret deal with a top drug manufacturer looking to underhandedly market addictive medications. The tool was still being used as the number of overdose deaths were climbing. From 2016 to spring 2019, the alert went off about 230 million times.
Practice Fusion may still be getting used, too, if its purpose wasn’t uncovered by a government investigation. When it was discovered, the program creators agreed to pay $145 million to resolve civil and criminal cases, according to court records in Vermont federal court. Practice Fusion admitted to the scheme with “an unnamed opioid maker.”
In rolling out the program, Practice Fusion employees estimated that a drug maker could add as much as 3,000 patients and increase opioid sales by as much as $11.3 million. The contract also included a clause in which the drug maker 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. She called the Practice Fusion arrangement “nefarious and subtle.”
According to an internal Practice Fusion email cited in the court papers, the drug company considered it “all about marketing.” The settlement doesn’t name the specific manufacturer, but sources indicate it is Purdue Pharma, the maker of OxyContin.
In 2016, the U.S. Centers for Disease Control and Prevention put out new guidelines on opioid use for chronic pain patients. Practice Fusion and the drug company it was working with shared those internally but “did not incorporate the recommendations contained in those guidelines,” according to the court papers. The arrangement stood even after an attorney for the drug company voiced concerns and initiated a legal review.
Jamie Weisman, a dermatologist in the Atlanta area, has used its platform for five years and only recently learning of the intentions of the built-in alert. “It’s evil. There’s really no other word for it,” she said. 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.”
Practice Fusion admitted only to the opioid agreement, and “there has been no determination of liability” on civil claims, the Justice Department said.
“Across the country, physicians rely on electronic health records software to provide vital patient data and unbiased medical information during critical encounters with patients,” said Principal Deputy Assistant Attorney General Ethan Davis of the Department of Justice’s Civil Division. “Kickbacks from drug companies to software vendors that are designed to improperly influence the physician-patient relationship are unacceptable. When a software vendor claims to be providing unbiased medical information – especially information relating to the prescription of opioids – we expect honesty and candor to the physicians making treatment decisions based on that information.”
Health-software company Allscripts Healthcare Solutions Inc., which bought Practice Fusion for $100 million in 2018, said in a statement “the conduct predated the deal and it has further strengthened compliance at Practice Fusion.”