Patient drug use data at your fingertips

Patient drug use data at your fingertips – By Rachel Z. Arndt  | October 9, 2017

Every time Dr. Gina Huhnke writes a prescription for opioids, she first consults a number in the patient’s electronic health record.

That number, a risk score that providers can use to gauge a patient’s risk for a substance-use disorder, tells her whether she should prescribe the drug or instead have a conversation about drug addiction.

Sometimes even the patients themselves are surprised,” said Huhnke, director of medical affairs and emergency medicine at Deaconess Health System, based in Evansville, Ind.   

The score is algorithmically generated by a platform created by Appriss Health with information from prescription drug monitoring programs and patient health histories.

Wait a minute – how did this corporation get access to not only our PDMP data, but our full health histories?

So many law-enforcement and business interests feel free to browse through our medical information since it became electronic. I thought HIPPA had privacy protections – or is that only for the patients themselves and the office staff?

Forty-two of the 52 prescription drug monitoring programs in the U.S. use Appriss Health to access state data, drawing on the company’s Awarxe database, which catalogs all of a state’s controlled-substance prescriptions.

So Appriss sucks all the data off almost every state’s PDMP and keeps it for themselves to clandestinely manipulate any way they want.

Appriss can design its software and database however it wants, feeding our most private medical information into its “proprietary algorithm” which then arrives at our “risk score”, a secretly fabricated “magic number” that will decide whether we qualify for effective paincare.

Not my doctor, not another medical professional, but endless lines of code in the software from Appriss will decide my fate. And you can’t talk back because it’s a “proprietary algorithm” making the decision, not a human.

Am I the only one that sees a problem with this?

That information is integrated into pharmacy and clinical workflows with Appriss’ PMP Gateway, for which Appriss Health charges a fee per provider—except in several states, such as Indiana and Virginia, that have purchased licenses for all the providers and dispensers within their borders

  • Whereas a basic PDMP report might contain a historical list of prescriptions for, say, the last two years for a patient,
  • Narxcare visualizes that information and produces risk scores so providers don’t have to sort through heaps of raw data

—and it does so from within the pharmacy management system or EHR, including in those made by Epic, Cerner, Allscripts, eClinicalworks and Athenahealth. Narxcare has been around since early 2017 after growing out of software Appriss first released in 2011.

There it is again: they have access not only to our opioid prescriptions but our whole medical record.

How is this not a HIPPA or even Civil Liberties issue?

I’ve had depression diagnosed and treated with ongoing medication for decades, and that would bump up my risk score in such software. And I remember talking to my doctor about my anxiety – that would bump up my risk score even more.

I never consented to give all my medical information to some corporation that will use it against me and destroy my chances of ever getting opioid pain management again.

(Or is this another right we sign away in our “opioid contracts” or “pain agreements”?)

Appriss Health’s Narxcare analyzes the data.

These numerical scores are awareness triggers,” said Dr. Jim Huizenga, Appriss’ chief clinical officer. However, providers still need to talk with their patients, he said

Well, we’ve all learned how such “suggestions” end up becoming prohibitions.

The data make those discussions with patients easier, said Rob Cohen, president of Appriss Health. “They can now say, ‘I’ve got this score that was produced through machine learning, and based on this score, I think you should be concerned,’ ” he said.

It takes the judgment out of providers’ hands and patients react better.

So now it’s a good idea for medical judgment to be taken out of the doctors’ hands? 

Impersonal algorithms are taking over what used to be the deeply personal practice of medicine.

Instead of basing such a judgment on the personal knowledge your doctor has about you, perhaps from a long-running relationship, they insist we should base it on data that’s been processed and presented by some “proprietary algorithms”, whose inner workings cannot even be audited.

And if the result is wrong?

Who are you going to argue your case with? The algorithm?

the risk scores make patients more amenable to conversations, Huhnke said, especially when most patients have no idea that their doctors have this kind of information in the first place

What kind of “secret” information do these doctors have?

The data about us in the PDMP seems to be secret only to us patients, and now that our medical records are electronic, our personal information is routinely scanned by private corporations for their own ends.

When the algorithm used to calculate our risk score is a secret from everybody else, who knows what’s hidden in those hundreds of thousands of lines of code?

Since Deaconess began using Narxcare in May 2017, “I’ve had several patients who were not happy that I was able to access this information,” she said. “The risk score changes the conversation from, ‘We’re the police, and we’ve caught you doing something bad’ to ‘We’re the healthcare providers, and we’re here to help.’ ”

This is a joke, right?

When it comes to opioids, we’re not treated by healthcare and doctors anymore, we’re treated by algorithm and law enforcement.

See also:

 

7 thoughts on “Patient drug use data at your fingertips

    1. Zyp Czyk Post author

      …and appalled at what goes on with their personal “private” medical records. HIPPA privacy rules seem to be only for patients and doctors, while insurance companies and law enforcement have access whenever they want.

      Liked by 1 person

      Reply
  1. canarensis

    I gave up the idea of privacy quite a while back, and was all for somebody like an ER doc being able to see that I only get meds from one doc, one pharmacy, & hadn’t been to an ER for any reason in years, in the hope that they’d then be willing to treat me if I DID show up. HA! Of course it didn’t work that way.

    I repeat the appalled assertion of a friend who spent time in prison, after hearing what CPPs go through: we have far fewer rights or civil liberties than someone in prison or who has been in prison. Not just pain contracts but the mere fact of being people with chronic illnesses has destroyed our rights –to privacy, to adequate medical care, to not being treated forever as guilty of addiction & drug abuse, of anything & everything wrong and criminal and deserving of scorn and abuse. How foolish we are to have chosen to have debilitating health conditions these days.

    Liked by 1 person

    Reply
  2. canarensis

    Also…”the risk scores make patients more amenable to conversations.” Really? I’d love an opportunity to chat with all those patients who are happier to talk to their doctors after learning that what used to be the doctors’ decisions are now made by secret algorithms. I’ll bet they come riding to the meeting on unicorns.

    And basing anyone’s medical treatment (or lack thereof) on a hypothetical “risk score” that the medical provider has no control over is nuts. As this blog author has pointed out more than once, you can’t apply a statistical probability to an actual individual’s case. This is like proactively jailing people because their racial & socioeconomic background indicates they’re at ‘high risk’ for committing a crime, before they’ve ever done anything of the sort. That’s supposedly illegal –tho it’s apparently fine –laudable even– to do to chronic pain patients.

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  3. Scott michaels

    Ever since 9/11 our country and homland security has use the excuse of himeland security to invade our privacy. They listen on our phones for words like bombs, jihad, and taking down targets. They also can listen in on those phones as well as our tv sets to see what were up to. They now have taken it to the next level. Since junkies buy heroin they say that the money go to terrorists, how stupid is that) they also consider patients that use opioid pain relievers a threat and that is how they excuse themselves for getting our medical information. Its a travesty, its now the American way. People boycott the largest shoe company in the world because a black man kneels at his football game. He kneels because he doesnt like the way black people are treated by police. Thats the only reason. But the govt still spits out propaganda hes a traitor disrespects the vets and the flag. Noooo, thats not true. But that is what has become of america. WE DO NOT TRUST OUR CITIZENS, WE BELIEVE ALL PAIN PATIENTS ARE LYING AND FAKING IT JUST TO GET DRUGS SELL THEM AND SEND THE MONEY TO TERRORISTS. THATS WHY THEY INVADE OUR PRIVACY AND IGNORE HIPPA RULES. EVERYBODY IN THE WORLD CAN NOW GET OUR MEDICAL RECORDS, THEY ALL KNOW WHAT KIND OF PAIN PILLS WE TAKE AND HOW MANY. IMAGINE FUTURE EMPLOYERS CAN CHECK TO SEE IF WE EVER TOOK AN OPIOID. NASTY EX SPOUSES CAN USE THIS TO GET CUSTODY OF CHILDREN. THE GOVT SAID WE ARE BAD PEOPLE, SO WE MUST BE. I AM REALLY STARTING TO HATE THIS COUNTRIES SO CALLED DEMOCRACY AND THE FREEDOM WE BRAG ABOUT SO MUCH. ITS A VERY DANGEROUS TIME FOR ALL OF US. OUR PERCEPTION OF FREEDOM AND THE CONSTITUTION ARE AT RISK OF GOING AWAY. WOULDBT WE BE BETTER OFF KNOWING OUR FREEDOMS AND PRIVACY HAVE MANY STRINGS ATTACHED TO THEM THEN LIVING A LIE. TO THE REST OF THE WORLD AMERICA IS JUST A PIWERFUL THUG, IF YOU DONT DO THINGS OUR WAY WE CUT YOU OFF AND BLOW YOU UP.
    ITS TIME TO WAKE UP AND TAKE A STEP BACK AND RE THINK OUR PRIORITIES

    Like

    Reply
    1. Zyp Czyk Post author

      You make some good points. What’s happening to us seems part of an increasingly survivalist culture which has only scorn for those who are less fortunate in life.

      Like

      Reply

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