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Electronic patient records systems used by thousands of doctors were programmed to automatically suggest opioids at treatment, thanks to a secret deal between the software maker and a drug company

To doctors opening patients’ electronic records across the U.S., the alert would have looked innocuous enough.

A pop-up would appear, asking about a patient’s level of pain. Then, a drop-down menu would list treatments ranging from a referral to a pain specialist to a prescription for an opioid painkiller.

Click a button, and the program would create a treatment plan. From 2016 to spring 2019, the alert went off about 230 million times.

The tool existed thanks to a secret deal. Its maker, a software company called Practice Fusion, was paid by a major opioid manufacturer to design it in an effort to boost prescriptions for addictive pain pills — even though overdose deaths had almost tripled during the prior 15 years, creating a public-health disaster. The software was used by tens of thousands of doctors’ offices.

Its existence was revealed this week thanks to a government investigation. Practice Fusion agreed to pay $145 million to resolve civil and criminal cases, according to documents filed in a Vermont federal court. Practice Fusion admitted to the scheme with an unnamed opioid maker, though the details of the government case closely match a public research partnership between Practice Fusion and Purdue Pharma Inc., which makes OxyContin.

Representatives for Purdue Pharma and the Vermont U.S. attorney declined to comment. 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, but didn’t answer specific questions about the settlement.

As deaths from opioid overdoses mounted, states and citizens accused manufacturers in lawsuits of pushing drugs while downplaying risks. Many millions of pills were dispensed at pain clinics in rural areas, fueling a vigorous street trade.

The Practice Fusion case shows a more subtle method of reaching drug consumers. Employees estimated internally that the drug company could add almost 3,000 patients and bolster opioid sales by as much as $11.3 million through the partnership. Under the contract, the drugmaker paid Practice Fusion almost $1 million.

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