EHRs blur line between marketing and assistance: researchers

EHR use up 10%, as small practices tame data crunch
EHR use up 10%, as small practices tame data crunch

Professionals have been griping about electronic health records for some time, even though adoption as spiked: use among small practices jumped 10% in the first half of this year, and about 70% of hospitals implemented EHRs at the beginning of this year.

Perceived as onerous and inconsistent, EHRs have also provided marketers with an ability to get in front of physicians through alliances like those between Merck and Practice Fusion, or efforts like those of the Physicians Desk Reference and eMPR which offer brands front-and-center attention throughout a professional's day. (eMPR is published by MM&M's parent company, Haymarket Media.)

Drs. Christopher Manz, Joseph Ross and David Grande, write in a Perspective piece in the New England Journal of Medicine that this marketing access is another reason to be disgruntled, because EHRs have essentially become marketing pathways that undermine no-see policies that many hospital groups set up for the very purpose of keeping marketers and diagnosticians separate.

Among the ways the doctors say digital access is helping pharma become smarter: digital tools provide the same feedback digital wanderings provide for everyday searches, allowing EHR vendors, like Practice Fusion, to sell anonymous clinical trial data pulled from patient records. They also note that networking services like Doximity and Sermo are part of the marketing loop because they provide sponsored discussion forums and surveys in which doctors can trade information and opinions in exchange for rewards. Epocrates also gets dinged—the doctors note that the “widely used mobile application for physicians” tracks search patterns and use this information to serve DocAlerts that are usually industry sponsored.

Some of their concern lies with how, and if, professionals perceive this outreach as marketing or assistance. Using eCoupons as an example, they note that doctors may consider this a financial management tool “rather than marketing.” They are also concerned that the seamless integration of medical information and marketing will make parsing the two increasingly difficult.

Their recommendation: apply the same logic that has been used to police traditional marketing practices to digital ones, beginning with transparency requirements for how EHR data, such as what personal and prescribing data will be used. They also urge professional organizations to create reporting standards, and propose that Health and Human Services embed transparency requirements into EHR meaningful use descriptions.

The trio also recommend applying Sunshine rules to digital outreach, requiring, for example that payments linked to networking services challenges, be reported under the Physician Payments Sunshine act. They also propose that professional groups implement “firewalls to keep marketing out of patient visits—as they did with free pens and other traditional marketing tools.”

There is also a more straightforward approach, which is the recommendation that health systems and groups refuse to use EHRS and other tools that have marketing add-ons.