Phreesia report

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As previously promised, I did some research into exactly what and how Phreesia is; here is my report.I contacted Phreesia, and spoke with Mike off, one of the founders and the individual demonstrating Phreesia on their Internet website. We spoke for quite a long time. I wanted to make sure that I had a very good understanding of what and how he was trying to do, if what he was providing would have any benefit to ideal micro-practice, and what if any downsides were there.Specifically, drug companies pay him for however many hits there are by a patient to their sponsored information once the patient goes through the registration, demographics, medical history and complaint pages.The information is not presented in a drug neutral format, like "if you have a problem with headaches and insomnia, you should talk to your doctor, this message courtesy of Pfizer", rather it is presented in the form of the benefits of a particular drug, targeted to the

individual patient, since the patient has told Phreesia what medical problems they have. Although HIPAA compliant, I reviewed their business associate agreement with Mr. off, and there is nothing to prevent Phreesia from using the patient information in whatever ways they see fit, as long as those ways are HIPAA compliant. Essentially, it is designed to target individual patients with their individual problems at the point of entry to the doctors office, before the doctor sees the patient, and with a specific medication, presented in the form of educational material. It is obvious this is designed to alter our prescribing habits, having recruited the patient as the drug company representative.This program is designed to do something far more dangerous than at first look. This is not just advertising; this is a direct insertion of the drug company with its financial interest into the very heart of the doctor-patient relationship, performed

by none other than the patient, at the direction of the drug company.At best, any discussion of the advertised product merely takes additional time, and time away from the patient's needs, the very thing we need to do our job, and for which we get paid. At worst, this helps to create an adversarial relationship, where the patient may think that the doctor is not doing everything he or she can for the patient's benefit.The fact that Phreesia is offering this service for free as long as a certain number of patients per week is met, and as long as the sponsored information is not totally removed, is laughable. This is a blatant scam by the drug companies, using a new and sophisticated high-tech weapon, to continue to attempt to influence the marketplace, in a very insidious manner.I think the idea of a patient coming in and being able to swipe a magnetic strip and have that information check eligibility and benefits, populate demographic fields in an

electronic record, go to instant medical history or something similar and present that data to the doctor, would be great. I think that insurance companies may want to know when their patients show up, and to emphasize good health habits, and that may be a way to pay for such a service. Nonetheless, even in such a scenario, it gets ever closer to others being in the exam room with the doctor and the patient, necessarily altering the free and open discussion about that patient's medical condition and needs.When I go into the exam room with a patient, we are afforded a shade of opacity which descends to prevent advertisers, insurers, politicians from inserting their message into the doctor-patient relationship. Phreesia is a device whereby I, who stands at the door regulating who may come in my office, invites someone in, who always brings in someone else whom I may not want there.That is unacceptable. I told Mr. off that I am member

of a large group of doctors, and that I would be reporting this conversation and my opinion to the group. Mr. off wanted to know who was this group of doctors, and how could he participate in a discussion with them. I told him this group is for doctors only, and that I was not comfortable giving that information to him.My opinion is, in a phrase, this is blatant commercialism and totally unacceptable. I think this also very clearly demonstrates how much money there is in medicine from a pharmaceutical perspective. If we are going to continue to make a significant difference, we are going to have to work to reduce and eliminate the influence of the three major players, the drug companies, the private insurance companies, and the largest doctor organizations, geared to the needs of specialists. These are the three groups who control the money.Just my thoughts, hope that's helpful.LL

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