Ethical WTF: Telus Health secretly inserted drug vouchers into electronic medical records system

According to the Toronto Star, Telus Health’s EMR (Electronic Medical Records) system offered vouchers for more expensive brand name drugs. This “feature” was enabled in a 2016 software update with many doctors unknowingly activating it.

When doctors would go into the system, vouchers would sit alongside patient information, it would be non-obvious or hidden and it would look like part of the software:

The Star had found that brand name drug companies paid Telus to digitally insert the vouchers so that the prescription is filled with their product instead of the lower-cost generic competitor that pharmacists normally reach for.

What’s troubling is that Telus would send data about usage of the vouchers back to the marketing/advertising companies:

Telus said drug manufacturers paying to have their vouchers in the EMR receive “aggregated and anonymized, province-level statistics” on the total number of vouchers printed off for their products

Not only that but Telus has received subsidies (read: market distortions) for the implementation of their electronic medical records system:

Telus has been a significant beneficiary of a provincial government-funded program that saw more than $340 million distributed to doctors to adopt electronic medical records in their practices. Roughly half of the doctors who received funding went with a Telus-owned EMR that now includes the voucher feature.

The Ontario government has moved to ban this unethical and secretive behaviour. This “feature”, really a bug, will be turned off over the next few weeks. They are updating guidelines for certifying medical software.

That doesn’t go far enough. We need software developers and product and projects managers to be able to report ethical violations without fear for their jobs. We need stronger whistleblower protections.

Why didn’t the software developers working on this raise a red flag? They had a year, or longer, in which to do so. They could have done so either privately in the company, or if that failed to stop this unethical madness, to leak this unethical behaviour to the press or a government department.

Just following orders is not an excuse.

But let’s not lay all of the ethical burden on the developers.

Why didn’t the project or product managers raise the red flag? Did they only have visions of millions of dollars? Why did no one consider the possibility that government regulations, specifically a ban, could come into effect? I wonder what impact that would have on the too-often optimistic estimated ROI of that “feature”! It turns this money-making feature that Telus was tempted into by advertising companies into a massive liability. The government will look close at every future update to the software to ensure it doesn’t include this kind of advertising scheme.

The ethical situation when building software is getting worse (it’s already pretty bad from this Telus drug advertising case and the VW emissions testing case). We as software developers need to be making a greater push for free/open source software because it is auditable. We also need to be willing to raise the flag on unethical and illegal ideas.

We need stronger whistleblower protections for developers, designers, product managers, project managers and others in the tech industry to feel safe enough to blow the whistle on ethical violations.

Telus Bought Their Way Into Unethical Behaviour [Update: 9 October 2017]

I was searching for more information about the subsidies that the Ontario government has given out in hopes of spurring adoption of Electronic Medical Record management software when I found this. It’s an article about how Telus, the 3rd largest telecom provider, purchased Ontario’s largest provider of electronic medical record management software.

They also had more acquisitions in 2012:

“We’re very bullish about the potential of EMR software,” said Paul Lepage, president of Telus Health. Last fall [2012], the company acquired Quebec-based KinLogix and B.C.’s Wolf Medical Systems.

It turns out that every province provides subsidies and Ontario in particular provides $28,000 over 3 years:

…nearly every province now offers subsidies for doctors to make the costly switch from paper to computer records — a major barrier to some medical offices in the past.

In Ontario, doctors are eligible for a grant of $28,000 over three years to install the software, which has an estimated annual cost of $3,000 to $5,000 plus installation fees.

At the time, with the acquisition of MD Practice Software by Telus Health, Telus Health would have roughly 9000 doctors using their software. I’m not sure what the licensing fees look like, but if we do a rough estimate of $3000, Telus Health would earn $27,000,000. Most likely they’ve earned far more, and with their extra income from advertising brand name drugs in their software, they’ve definitely more than made their money back from their acquisition.

Let’s get some better numbers by looking at the Telus 2013 Annual Report (click here to view an online copy in PDF format):

TELUS Health became Canada’s largest electronic medical records (EMR) provider with the acquisition of PS Suite EMR. Our EMR solutions now reach more than 12,500 physicians across Canada. The deployment of Pharma Space®, our online prescription management portal, continued through pharmacy chains and banner customers of TELUS Health and, today, more than 250,000 health consumers are using these solutions.

What’s 12,500 multiplied by $3000? $37,500,000. Again, these are only rough estimates but they point to a lot of money to be made for Telus which is the largest player in the electronic medical records industry.

Looking further into this has opened a lot of questions:

  • At what point is it okay for a government to stop an acquisition?
  • How much in subsidies has Telus Health benefited from?
  • Why was this acquisition allowed to go through at all?
  • Why didn’t the Telus annual report for 2013 give a better breakdown of the Telus Health and business services earnings?
  • How much income has been earned by Telus Health in 2016 and 2017? How much of it came from subsidies and how much it came from the unethical advertising and upselling of brand name drugs?
  • Which drug manufacturers were using the advertising system? Do we know exactly what kind of reporting/metrics/analytics data was sent to them?
  • Which doctors offices are using Telus Health’s EMR system and which ones used the advertising/upselling feature?

Whenever I speak to other developers or people in the tech industry about this unethical behaviour by Telus Health, I always tell them that the Toronto Star article was great. However, it should have been three articles at least to fully investigate and cover the larger scope of unethical behaviour and the unearned advantages that Telus Health has gained from an acquisition that was unopposed and from the subsidies that they’ve benefited from.

This is why I’m writing Unevenly Distributed, a longer form column to tackle these bigger issues which are contributing to our presently unevenly distributed future.

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