Should drugmakers be able to sponsor alerts in your EHR system?

Experts remain divided

While electronic health record (EHR) notifications can be valuable to physicians, some industry experts have raised concerns about the use of sponsored alerts, the Wall Street Journal's Elizabeth Dwoskin reports.

Details of sponsored EHR alerts

Sponsored alerts are paid for by industry groups and pop up on a patient's EHR when they are due for health services, such as vaccines.

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Practice Fusion, an EHR software vendor startup, sells such alerts to drugmakers, insurers, and labs. The notifications then are displayed to them through its EHR products, which are available to providers at no cost. The company uses patients' health indicators and medical history to match them with preprogrammed alerts in real time.

Practice Fusion CEO Ryan Howard said there are currently around 112,000 health care professionals using its products in roughly 5.5 million offices visits each month. During a four-month study period, Practice Fusion said the alerts increased vaccinations by 73%, accounting for an additional 25,000 immunizations.

Despite Practice Fusion's reported success, the practice of sponsored EHR alerts is not widespread. Epic Systems delivers non-sponsored alerts in its EHR software, which providers must pay for. Meanwhile, athenahealth includes sponsored alerts in its medical reference mobile application, but not its EHR software.  

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Some experts say that sponsored alerts straddle the line between health promotion and marketing.

Joseph Kvedar, Partners HealthCare's vice president of connected health, acknowledges that the alerts could help to improve patient outcomes, but added, "It's a fine line between recommending some kind of guidelines-based care versus recommending something that is marketing or sales-driven."

Robert Wachter, associate chair of University of California-San Francisco's Department of Medicine, says that while anti-kickback laws prohibit drugmakers from directly paying physicians to prescribe their medications, no-cost software subsidized by drugmakers could be viewed as an incentive to physicians.

However, Ramy Fayed, a Medicare fraud expert at the law firm Dentons, notes that Practice Fusion's sponsored alerts do not violate federal anti-kickback laws because receiving the sponsored alerts is not a precondition for a physician to obtain the software at no cost (Dwoskin, Wall Street Journal, 3/3).

The takeaway: Experts are divided on whether pharmaceutical companies, labs, and insurers should be able to pay for special alerts in patients' electronic health records.

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