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.

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