Ethical Questions Raised about the New Physician Office EMR from Epocrates

Epocrates is a very successful smartphone app for physicians. The company recently announced the availability of an electronic health record (EHR) (see: Epocrates electronic health record raises new possibilities and ethical questions). Below is an excerpt from an article about this new product that may raise some ethical concerns:

...Targeted to small and solo physician practices, the [Epocrates EHR product] is a web-based software-as-a-service platform which will be offered on a monthly-subscription basis. At launch , it includes a native iPhone app that appears to include access to patient records as well as e-prescribing functionality, with iPad support reportedly in the works. Epocrates EHR will also include support for billing/coding, data analysis and reporting, and an interesting task-management feature....There are several factors that make this offering particularly unique and raise some interesting questions. First, given the wide-spread brand recognition, Epocrates is likely to be successful in signing up customers in its target audience. Since all data is stored remotely by Epocrates, they will be in a position to gather information on populations that would otherwise be left out of large prospective and retrospective studies typically run out of large academic centers. Also, it will be interesting to see how Epocrates integrates its mobile app offerings with its EHR....We can be sure though that if anyone is going to integrate mobile medical apps more directly with an EHR, it’s going to be Epocrates. However, this also raises a notable ethical question. As we pointed out recently, Epocrates main revenue source is from pharmaceutical companies, particularly through sponsored offerings built into Epocrates EHR like DocAlert and Mobile Resource Centers. In its recent statement to the SEC, Epocrates even acknowledges the importance of this revenue source and plans to grow it further by improving its free app portfolio. So where exactly does the EHR fit into this – is it being effectively compartmentalized from the rest of Epocrates which is largely driven by pharmaceutical revenue, money these companies are spending to influence physician prescribing practices? Is that even a responsibility Epocrates has?

First of all, a brief note about vocabulary. I tend to use the terms EHR and EMR interchangeably although a (h)ealth record is generally viewed as being broader than a (m)edical record. I also distinguish between an office/clinical EMR and a hospital EMR. The Epocrates product is clearly a web-enabled, cloud-based EHR/EMR designed for small physician office practices. Most exciting about this new product, emphasized in the article, is the integration with the iPhone/iPad; the company has clearly mastered this type of integration.

Very distressing to me, however, is the clear link of the company, and its software, to the pharmaceutical industry. I have blogged on numerous occasions about some of the ethical and legal lapses of some of these companies (see, for example: On the Corrosive Influence of Big Pharma on Academic Physicians; Merck Creates Phony Peer-Reviewed Medical Journal to Dupe Physicians; Details Emerge About Ghost-Written Medical Articles for Wyeth). I have also reluctantly come to the conclusion that even apparently trivial advertising connections to Big Pharma can lead to mischief. I had previously thought that inconspicuous advertisements in EMRs by drug companies might be tolerated if the companies were to bear the costs of these systems. I now believe that allowing these companies even a tangential relationship to physician-office electronic medical records is too risky.

Comments

[Findyourdrug.com]

As a customer I am looking forward to EMR. As I understand it I will no longer have to worry about retrieving my records from one doc when I go to the next one.

There is always some pain in change, believe me I know. But as the younger docs (no offense to Dr Graaf) begin to practice the EMR will become an accepted way of doing things.
Dr. Graaf's idea of taking notes rather than working on the computer is a great idea, he might consider taking it one step further by recording his appointments.

[Brian Jackson]

See also a great article on the ethics of the regular ePocrates app (as opposed to their EMR): http://www.nytimes.com/2011/07/29/business/the-epocrates-app-provides-drug-information-and-drug-ads.html?_r=1&scp=1&sq=epocrates&st=cse