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Health Care Policy and Law
May 11, 2020

Commercial Influences on Electronic Health Records and Adverse Effects on Clinical Decision-making

Author Affiliations
  • 1US Department of Health and Human Services, Office of Inspector General, Washington, DC
JAMA Intern Med. 2020;180(7):925-926. doi:10.1001/jamainternmed.2020.1318

Electronic health records (EHR) have been blamed for a range of ills from note bloat and physician burnout to medical errors and patient harm. Although these criticisms may be overstated, an insidious aspect of EHR has largely escaped scrutiny: corruption of clinical decision-making. Clinical decision support tools help physicians decide, among other things, when and how to prescribe medications. When properly implemented, clinical decision support promotes quality patient care. If these tools are corrupted by commercial influence, however, they can promote improper and excessive prescribing. The direct access to physicians and the assumption that these tools are unbiased and evidence based make them a potentially powerful marketing device. Moreover, clinical decision support has largely been spared the scrutiny applied to advertisements, pharmaceutical detailing, and other overt forms of drug company marketing.

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2 Comments for this article
Make EHR better with more regulation?
Brian Roebuck, MD | Hospital
Interesting article. It highlighted the persistent problem of money spoiling a good thing (independent minded doctors making independent medical decisions...obviously an ideal). But to suggest that the EHR purchaser vet the EHR supplier of wrongdoing is a stretch. That’s the duty and responsibility of the government not the public.
CONFLICT OF INTEREST: None Reported
That's why hospitals need a dedicated pharmacy/IT team
Cornelia Libal | Hospital
As a hospital pharmacist who designs and implements the EHR clinical tools discussed in the article, I cannot believe that hospitals and their pharmacy/IT departments do not question the logic that drives these decision support algorithms. You cannot buy these things off the shelf without vigorous testing and the knowledge of what the algorithm in the system is and how it aligns itself with local and national guidelines. Not enough due diligence by the hospitals before they put anything around medications, let along high-risk meds like opioids, into their live systems.
CONFLICT OF INTEREST: None Reported
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