Silicon Valley↔Israel↔India ҉ Fusing EHR Data
“Healthcare is broken. Insurance companies are innovatively bankrupt. There are huge hurdles to entry. The biggest companies in the world can’t solve this problem; even Google can’t build a good personal health record system. Doctors are frugal. Patients are lazy and don’t care about their health. You guys are choosing a very hard path.”-Ryan Howard, CEO of San Francisco-based Practice Fusion, at an event in Mountain View, September 2011*
Ironically, open source and a sharing culture participated in fusing patient data. In much the same way multiple sources and countries have reportedly attempted to generate energy from nuclear fusion power reactors as I point out at epowerearth.com
Sound familiar Microsoft? 😉
Software vendors, if you wiggle it out of them, will tell you that once the sale is closed, companies will undoubtedly face technical problems. Adding to this challenge is getting all employees easily and quickly trained. But that’s your firm’s problem.
Working in law firms just out of high school, I witnessed this close up. I came across an article in the California Lawyer Magazine which offered “trouble shooting” suggestions and advice in contracting vendors. I approached the firm’s partners pointing to the articles. The puzzled expression on their faces was followed with remarks like, “You’re reading our magazine? You’re not a lawyer.” Or, “Not your job young lady. Don’t you worry your pretty little head about these problems.”
After leaving the firm I managed to obtain a subscription. Standard protocol was supplying a little bar number. Of course, adding an “Esq.” after one’s name was a nice touch. It seems all the publisher wanted was payment. No problem.
Exporting Schemes to Israel and India. Or Vice Versa?
The JERUSALEM POST August 2020 article highlights Israel’s “Sheba Medical Center, Tel Hashomer has partnered up with healthcare information technology firm Allscripts.” Israel’s “Dr. Eyal Zimlichman explained, “With the need in rapid changes these days, we need a leader like Allscripts who’s agile, open and connected to the needs of patients, clinicians and governments.”
Dr. Zimlichman, speaking of governments, are you aware of the Department of Justice investigations and lawsuits? Right, its other people’s lives, data and money.
From Israel to India, “Allscripts is partnering with India-based health IT company Manorama Infosolutions to develop an integrated healthcare management information system and health information exchange platform, according to a Feb. 18 news release” according to Becker Hospital Review.
Health industry is not the only sector “cutting in” on the EHR action. Ideal for global ventures, “Dozens of companies, from giants like General Electric to tiny startups like Y Combinator-backed DrChrono, are jumping into the market created by the incentive scheme.” Reports also point to Microsoft.
Microsoft and Governments, this is where they come into the EHR space, “Manorama uses Microsoft’s platform to host technology including EHRs, telemedicine and patient portal solutions. By offering the integrated dbMotion [or doMotion] solution, health policy administrators and authorities will be able to implement and track healthcare policies using population health data and central EHRs.”
DATA Sharing with Silicon Valley “Angels”
Investors and/or Founders of Microsoft, Pay Pal, Facebook, Google, Apple, and yes the e-commerce giant, Amazon, appear to have taken a bite of the big data pie.
Angel investors typically practice innovation diversification. Practice Fusion’s Ryan Howard xconomy.com interview reported that “The 110-employee company has raised roughly $34 million in venture support—most of it in a big April round led by Peter Thiel’s Founders Fund.” Users, looks like your “pal” funds its ventures with your pay.
Also “Early seed investors included the Silicon Valley-based investing group Band of Angels and former Intuit executives David Wu and Mark Goines. Morgenthaler Ventures, Aydin Senkut’s Felicis Ventures, and Salesforce.com joined in for the startup’s $5 million Series A round in January 2010.”
Allscripts appears to have capitalized on tech companies’ platforms use of “open source.” CEO Paul M. Black spoke of their company’s “commitment to…capitalizing on our 13 year commitment to an Open platform.” Black’s words resonate with those of Ryan Howard, reported founder and past CEO of San Francisco-based Practice Fusion:
“The biggest selling point for Practice Fusion—and the factor explaining its rocket-like growth—is that it’s completely free to doctors. The startup makes money not in the usual ways for enterprise software companies—subscriptions, consulting, training, support—but by showing ads in the browser alongside patient data.”
Howard may find he was partly correct. “But the system that enables all this has to start with patient records—not with Google Health-style personal profiles…” Next employee data linked to professional profiles accessed via Microsoft’s LinkedIn?
Re-Stimulating EHR and TeleHealth
The much awaited U.S. 2021 Federal Stimulus Package brings to mind Wade Roush’s excellent article, Practice Fusion Bids for Dominance in the Doctors Office with a Free, Ad-Supported Electronic Health Record System.” Roush points to the “2009 federal stimulus package to spur adoption of electronic health records (EHRs). Doctors who implement EHRs in their practices before 2015 are eligible for up to $44,000 in extra payments from Medicare; if they don’t convert by then the reimbursements they get from Medicare will be docked by 1 to 3 percent.”
Critics argue that spending proposals meshed into the Stimulus Package are unrelated to economic downturn. It appears the 2020 scheme is to capitalize on past systems of EHRs and pandemic created lockdowns directing patients to platforms conveniently facilitated by telehealth where providers can easily and quickly prescribe meds via telemedicine.
Also, in the proposed $1.9 Trillion package with several billion going to California, I see opportunities to cash in from the 2020 economic crisis as those in 2008. How? According to xconomy.com “Practice Fusion’s system earned full certification from the Department of Health and Human Services this June, meaning users are eligible for the full $44,000 in payments per practice.” Given US bureaucracy, I imagine this loophole is still open after 10 years.
Practice Fusion’s CEO interview in same paper, pointed out that “Doctors can’t afford EHR technology. The average family physician in California makes $120,000 a year.” I imagine doctors will jump on an EHR deal if they can use government money. Or will they heed the warning of other doctors? Recall the “class action lawsuit against Allscripts Healthcare Solutions. Lawsuit argues Allscripts:
“Misled its physician customers about the quality and functionality of MyWay” electronic health record (EHR) software which was sold to approximately 5,000 physicians across the nation from 2009 until Allscripts withdrew it from the market at the end of 2012. The cost of the software, according to the law firm’s website was “approximately $40,000 per physician to implement.”
*Practice Fusion workings with physician and EHRs may go back over 10 years. However, the 2020 Pandemic served as a major distraction from domestic back room deals to international schematic partnerships.
FBI: Follow the Doctor, Follow the Data
“Press extension 106 for Clinical Trials.” Similar messages can be heard when dialing providers. That is, providers who conveniently refer patients as candidates for clinical trials. Insurance and Pharmacies are supplied clinical notes. But who is the “middleman?”
Calling a provider, a recorded message provided a phone number, 1 866 326 8755. I called between 9:00am – 4:00pm (Pacific Time) and was asked for an account number. Not having one I was told by the respondent that she could only provide information to those supplying an account number. “My research firm was looking for a new vendor,” I said. “What’s this company’s name?”
It seems the lure of “new business” was too good for her to pass, even if it meant breaking company/provider protocol. Name of the company? No problem. “Allscripts” she said.
Immediately, I recalled DOJ reports about Allscripts and its subsidiary, Practice Fusion:
Department of Justice. Office of Public Affairs. FOR IMMEDIATE RELEASE.
Monday, January 27, 2020. “Electronic Health Records Vendor to Pay $145 Million to Resolve Criminal and Civil Investigations. Practice Fusion Inc. Admits to Kickback Scheme Aimed at Increasing Opioid Prescriptions.” Not surprisingly, reports point to increased use of opioids in 2020 due to various factors attributed to COV-19 and the pandemic.
DOJ may wish to renew investigations. “Founded in 2005, Practice Fusion offers an EHR tailored for smaller, independent physician practices.” Article points to the DOJ lawsuit which notes that “the company extracted kickbacks from pharmaceutical companies in exchange for implementing clinical decision support (CDS) alerts in its electronic health records (EHR) software designed to increase prescriptions for their drug products.”
Government, tech companies, and pharma financially incentivizing physicians and hospitals to digitize health records appear to have facilitated the situation. In 2014, ehrintelligence.com reported that “After engaging in several lawsuits in 2012 and 2013 involving the ill-fated product, Allscripts has been found guilty of deceptive business practices in North Carolina by an arbitration panel that decided in the favor of Etransmedia Technology, a reseller of MyWay products.”
Practice Fusion was acquired by Allscripts two years before DOJ notice. “Brian Farley, Allscripts’ chief administrative officer and general counsel, said in a comment to CNBC that the company is “pleased” to complete the settlement and that the conduct was disclosed prior to the acquisition in January of 2018.”
Christina E. Nolan, U.S. Attorney for the District of Vermont, statement in the DOJ public release, “We cannot — and will not — tolerate technology companies influencing patient treatment merely because a pharmaceutical company provided a kickback.” Madame, what is intolerable is it took the DOJ and FBI over a decade to complete the investigation fining a few million a company that is reportedly worth billions. Where’s the deterrence?
Such outcomes provide incentives across other sectors. Consider high costs of “specialty medications.” Imagine if a physician and vendor were to disregard U. S. Attorney David L. Anderson of the Northern District of California, “Prescription decisions should be based on accurate data regarding a patient’s medical needs, untainted by corrupt schemes and illegal kickbacks.” Counselor, “should” is for suckers. Recall my September 2020 paper, “PBM: What Doesn’t Kill You Makes Us Money.” Or, ask the FBI.
Timothy M. Dunham, Special Agent in Charge of the FBI’s Washington Field Office, Criminal Division stated, “The FBI is committed to working with our partners to bring to justice the perpetrators of healthcare fraud in all its forms…” Sir, specialty drugs prices are in the thousands and expected to increase. And with PBMs brokering deals between physicians and pharma vendors, the opportunities are exponential when they combine EHR and Tele Health.
Just ask Microsoft. According to zdnet.com, “HealthVault is a service for storing individuals’ health and medical records and information so they can be shared with health professionals. Microsoft launched a beta of HealthVault in 2007 and went live with the service in 2009.”
Interesting, HealthVault service was reportedly shut down November 20, 2019, about two months before the DOJ January 27, 2020 publicly released investigations on Practice Fusion Inc. Federal Agents, where did users export their data to? Another EHR?
A robber was reportedly asked, “Why did you rob the bank?” Response, “Because that’s where the money is.” Practice Fusion’s CEO also reportedly said, “In today’s market, the doctor controls the flow of data.” But who controls the doctor?
FBI, follow the doctor. That’s where the data and the money are.