Big Data on Blood

How the American IT company Practice Fusion deceived doctors and what it means to us

In December 2016, a weekly incidence and mortality base (MMWR, Morbidity and Mortaly Weekly Report) produced by the US Department of Health, a report called “United States 2010–2015 was published: increased mortality due to overdoses of narcotic and opioid drugs”.

The report began with such a phrase: “Mortality due to an overdose of drugs tripled from 1999 to 2014. Of the 47 thousand 55 deaths that occurred in the United States in 2014, 28 thousand 647 (60.9 %) fall on opioid drugs. ”

The numbers are quite everyday, if not for the nuance: in the statistical report it was not about drug addicts, but about patients to whom doctors prescribe drug painkillers. Methadone, fentanil, Promedol, Meperidine, Oximorphone, Buprenorfin and many more different natural, synthetic and semi -synthetic opioid analgesics.

Why an overdose happens, it is not difficult to guess: a person suffering from unbearable pain is ready to get rid of torment for anything. Drink 5 tablets with a glass of water instead of 2 seems to be such a simple solution ...

Another thing is incomprehensible: where did this triple come from in the statistics of deaths from overdose? The Ministry of Health was lost in conjecture. Two years it took to guess respectable corporate outlines, and then smoothly flowed into the trial.

There is such a wonderful company in San Francisco, called Practice Fusion-one of the leading software developers for Electronic Health Records (EHR), electronic medical cards.

The company Practice Fusion was created in 2005 in the name of a noble purpose: to tear out the conservative community of doctors from wretched computerization of the last century with all its multi -format electronic tables and databases, designed at best with the help of Microsoft Access and inhabited from the external world of an intranette of the hospital or university.

Practice Fusion said to the doctors: “In the yard of the 21st century! Age of the Internet, social networks, Big Data, ratings, reviews a la Yelp and Uber style! ”

“You, Aesculapius, of course, consider yourself smart,” the Practice Fusion doctors exhorted, “but where do you compete with the collective mind of the inexhaustible treasure of knowledge and experience?” You just want to want, and we will introduce you to this treasure! ”

The Aesculapius of America joyfully nodded: “We want! Of course we want! "

Practice Fusion has developed software that not only tolerated the routine of data to the Internet - an anamnesis, the chronology of patient visits, the results of the tests, prescribed treatment, but also analyzed all this diverse information, and then gave the attending physician recommendations in an extremely unnecessary form.

These recommendations are based on a tool called Clinical Decision Support (CDS) (support for the adoption of a clinical decision). Today, the state -owned health structures are considered to be CDS for almost a key criterion for professional diagnosis and treatment, because this tool "significantly improves the quality, safety and efficiency of healthcare."

The company Practice Fusion was among the first to bring out available programs for medical document management online, supplemented by CDS modules, so deservedly received hundreds of millions of dollars of venture capital, expanded and healed in a wide leg.

The practical implementation of the CDS in the Practice Fusion software (by the way, free-amazing selflessness for businessmen from programming!) It really looked unobtrusive: at some moments, a window surfaced on the screen with a proposal to evaluate, for example, the level of painfulness of the patient. The doctor put a box in the list of the proposed options and received a long list of tips in response: from standardized treatment algorithms to a complete indicator of drugs suitable for this case.

Technologies that helpfully deliver collective wisdom to any rural doctor, well, aren't the triumph of science?

Further, I quote the United States against Practice Fusion already in the case: “Starting in the fall of 2013, the defendant received a reward from the pharmaceutical company (“ Pharma Co. X ”) in exchange for the introduction of a special pop -up hint, known as CDS, in the program for maintaining electronic medical cards, developed by Practice Fusion. The hint brought doctors to clinical actions, the result of which

A disproportionately high amount of prescribed prescriptions for an opioid drug of prolonged action, developed by Pharma Co. X ".

By the way, the pseudonym Pharma Co. X is such a bashful-shed secret of the postgraduate. Los Angeles Times, journalists in an instant, calculated the pharmacist and named by name - Purdue Pharma Inc., and his opioid drug that appears in the case is OxyContin.

It is funny that all this hellish crime has grown out of good intentions - this is that we are now discussing not exclusive moral monsters, but an ordinary corporate mainstream, paved with ideas of progress and technological optimism.

Negotiations between Practice Fusion and Purdue Pharma began with the proposal of California programmers to develop a warning system that would be able to identify patients with a high risk of getting used to opioid drugs. However, then the noble idea smoothly flowed into the contract, according to which the Practice Fusion was supposed to develop CDS, which first detecting patients who had never previously taken opioids, and then unobtrusively pushing the attending physician to discharge OxyContin prescriptions.

It is indicative completely insignificant - taking into account the potential damage to the health of society - a taxpiece of services of computer code masters: 1 million dollars.

From July 2016 until the spring of 2019, when the criminal conspiracy of programmers and pharmacists fell into the view of the law enforcement agencies, the Practice Fusion clinical solution has surfaced 230 million times on computers of the attending doctors (!).

In a memorandum published on January 27, 2020, the special agent of the FBI Timothy Danham accused Practice Fusion of inciting an epidemic of opioid deaths in the United States.

Now I suggest that the reader enjoy the Grand Final. How do you think this horror ended in court? Do not believe it:

Practice Fusion agreed to pay compensation in the amount of $ 145 million

In exchange for lifting charges of numerous criminal and civil lawsuits. The outcome caused the delight of the media that emphasized the unprecedentedly high amount of the compensation.

The court decision also had the moral and captain of the component: Practice Fusion voluntarily pledged to draw a special website condemning the bad affairs of the company.

I don’t know how you, reader, but for me this monstrous story was the last straw that overwhelmed a cup of disgust before the civilization that we built.

It would seem, what do we, the post-Soviet (now-non-Soviet) people, to some California gang of programmers who have entered into a criminal conspiracy with a gang of pharmacists?

The problem, however, is that Practice Fusion is only an ordinary brick in the monumental obelisk of immorality, which was built by science and business that entered into a criminal conspiracy.

The reader probably drew attention to the period during which the Practice Fusion unobtrusively and objectively pushed the opioids of his partner Purdue Pharma. The conspiracy has acted since the launch of the clinical solution of the Practice Fusion to identify pain thresholds in 2016 and lasted until 2019.

Now let's recall the statistics from the weekly bulletin of incidence and mortality: from 1999 to 2015. In other words, the triple of deaths from overdose by drugs and opioids happened long before Practice Fusion appeared on the stage.

What is this talking about? Only about one thing:

Practice Fusion is not exclusive, but the norm. The norm is at least the last 20 years.

In my opinion, in the history of Practice Fusion there is no binding to American realities and specific participants in the trial. This story is organically located among the grandiose scams, which accompany the era of IT symbiosis with the greedy nature of man.

At one time, I probably investigated all the major financial fraud that became possible thanks to information technologies - from Enron and Worldcom to Refco and Tyco - and I should admit: there have never been such impudent and affable theft in the history of mankind. Moreover, the volume of theft is shocking: $ 200 million, $ 800 million, $ 2 billion, $ 4MLD. Nobody could even dream of such numbers in the pre -Internet era, but in modern scams this is the norm.

If you look at the crimes of the business of the past, you will see the remnants of morality in the seemingly unsightly fraud. Even the odious father of Pyramid Charles Ponzi motivated his stingy scam to help a simple person to break out of a vicious poverty circle (and many, by the way, broke out). Of course, all this was a hypocrisy, nevertheless, it gave out the presence of a moral imperative at least at the level of the subconscious.

Modern business has reached a unique apotheosis precisely in a complete abandonment of ethical guidelines. For money in the IT era, a white collar is ready to go for absolutely everything.

From the latest: the crypto -Bares managed to spread millions of free screensaver with a portrait of basketball player Kobi Bryant, who crashed by helicopter on January 26, 2020. A script was built into the screensavers, which after loading secretly used the resources of the victim’s computer for mining Monero cryptocurrency.

Against the background of this, stories are no longer surprising that in 2019, more than 70 million customers of 42 financial organizations of Russia were in open sale.

It is funny that these data are drained by the employees of the IT departments of the banks themselves.

Never before Pecunia non olet (money did not smell) to such an extent. The reasons for such an amazing exclusion of ethics from a business characteristic of the era of digital technologies have yet to be studied thoroughly. However, today the layman, far from IT, should be tightly assimilated with the axiom: the digital world is a hostile world. Whenever you go on the Internet, you fall into space, the global vector of which is to cash in on a gullible victim. If you do not build a priori distrust of everything and everyone in the norm of behavior on the network, you yourself will become a victim sooner or later.