Phreesia gives doctors free wireless WebPads (a modified tablet PC). Patients waiting for appointments use the device to describe their symptoms and demographic information. Then, the WebPad displays relevant health information, even suggesting questions to ask the doctor. Phreesia receives payment from companies when patients view their sponsored information.
Phreesia CEO Chaim Indig said his company creates a win-win-win situation. Doctors spend less time asking basic questions, and collected information can be readily placed in electronic or paper medical records. Patients see the doctor better informed and less frustrated by long wait times. And companies that want to get their message to particular groups of patients have a highly efficient way to do so.
But some observers are worried. Richard Kravitz, a professor at the University of California, Davis Medical Center, studies how doctors decide to write prescriptions. This kind of technology could improve health care, he said, but that depends on the information provided. "The idea doesnt worry me, but the business model worries me a lot. All the incentives will be to push higher [drug] utilization."
Others object that marketers have no place in doctors offices and raise concerns about privacy. Phreesia can accumulate non-identifying information collected from patients for market research, but information is not tied back to an individual, Indig said, adding that his company does not even provide information at the level of individual practices, which drug companies could use to dispatch drug salesmen. "Were not selling any patient information. Were selling access to reach a patient," said Indig.
Another complaint is that patients wont distinguish advertising from non-biased advice. Indig said Phreesia identifies what information is sponsored and provides much non-sponsored information including news articles. Physicians can also request that WebPads offer links to specific articles or information about their practice.
Steven Lamm, a physician in New York, helped pilot test Phreesias technology, but is not paid by the company. Lamm said the WebPads in his waiting room give patients something productive to do while waiting to see him and gives him an efficient way to collect patient information. The sponsored information doesnt bother him, he said, because patients are already bombarded with sponsorship in doctors offices, and patients only access information if they want it.
"What makes pharma advertising different is that you still have a gatekeeper," said Indig. "I dont think by saying, You should talk to your doctor about this, youre doing harm." Besides, he said, much of the problem with drug advertisements is that it reaches all patients, sometimes prompting patients to request drugs not intended for them.
But Kravitz says that, within reason, doctors tend to give patients what they ask for. In a study using actresses posing as patients, Kravitz found that patients who ask doctors about medicines are more likely to get prescriptions for them, both when drugs were warranted and when they were not.
Doctors blogs on Phreesia are mixed, ranging from praise of a no-fuss, free service to criticism that the technology interferes with the relationship between doctor and patient. However, Kravitz thinks that doctors will be wary of using the technology, especially if it seems like just another way for drug companies to get inside doctors offices. "It could get people to ask about conditions that they dont have and for drugs they dont need."