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Nov 2
Phreesia's President & CEO Responds To Waiting Room Marketing Post
Earlier this week, I posted an article focusing on how pharmaceutical companies are marketing to patients in the waiting room.  In my post I highlighted the efforts of several companies, including Phreesia, which develops WebPads that patients fill out and hand to their physicians.  Phreesia is a free service that is supported by its sponsors.  Many of its supporters are are pharmaceutical companies. 

Phreesia has been criticized by some physicians who have asserted that the company is conducting market research on patients without their knowledge or consent and providing its data to drug firms.   Recently, Dr. Adriane Fugh-Berman wrote a post on the Hastings Center blog, Bioethics Forum in which she said:

"The doctor gets an electronic copy of a patient’s health questionnaire, but so does the pharmaceutical (or medical device) company sponsors, which uses the personal medical information (with names removed) for marketing purposes and to gather data on the composition of a physicians’ patient pool."

Phreesia's Response Leads To More Questions

After I published my post, I received this response from Phreesia's President and CEO Chaim Indig:  "Berman's comments regarding Phreesia's business model are false and unresearched. Phreesia does not share patient data with its sponsors. In fact, Phreesia does not keep any patient data."

Upon reading his comment, I was intrigued.  I wondered, what information is Phreesia collecting and how it it used?  During my research, I found an article from the September 2005 issue of Pharma Marketing News discussing Phreesia's data collection activities.   In the article, John Mack, publisher of the publication, notes:

"Phreesia can . . . report back valuable de-identified information about patients to the sponsor. When the  patient interview has been completed and the report transmitted to the doctor, the information provided by the patient is stripped of all identifying markers (name, SSN, etc) and stored in a Patient Response database.  These data are aggregated in a report to sponsors . . . Phreesia is committed to preserving patients' privacy and complies with all HIPAA laws.  Any information gathered on the WebPad can in no way be tied back to any individual." 

On its face, Mack's article and Indig's comment appear contradictory.  Clearly, Phreesia is collecting data, but is it conducting market research on patients without their consent?  What information is it sharing with its sponsors?  These are serious questions that deserve answers.  To learn more, I contacted Indig and asked him to clarify his remarks and provide more information about Phreesia.  My interview with him is published below.  His comments have been edited for style and length.

Chaim Indig's Commentary

Q:  What is Phreesia and how does it work?
A: Phreesia provides customized patient intake and education at no cost to physicians in their practices. The Phreesia solution includes the leading edge PhreesiaPad™ which adds immediate value to the physician’s practice by gathering comprehensive intake information and chief complaints, decreasing the time spent asking basic questions, improving patient flow and reducing administrative time. Based on the patient’s responses they are taken to a customized portal with relevant educational, therapeutic and condition specific information.
Q: How does Phreesia generate profits if it is provided to physicians for free?
A: Phreesia generates revenue from the sponsorships of its portal.
Q: What attracts sponsors to Phreesia? 
A: Sponsors are attracted to Phreesia because they are able to educate and inform patients about their health before they see their provider thus aiding the dialogue between patient and physician. Another big benefit to sponsors is that Phreesia is able to address the importance of adherence and compliance with patients, which is rapidly becoming one of the biggest problems in healthcare.
Q: What has been physician response to Phreesia?  Have you received any negative feedback?
A: Response has been phenomenal from physicians and their staff.  Doctors love Phreesia because they can:

- Gather and produce more legible and comprehensive patient intake documentation

- Reduce administrative time by having less collation and paper handling

- Keep patients busy using the PhreesiaPad while educating them with relevant healthcare information

- Improve patient flow

- Place collected patient information in electronic or paper medical records
Q: My research indicates that you are collecting non-identifiable information from patients and that you don't provide certain types of data to sponsors.  What kind of information are you collecting (if any)? 
A:  We do not provide any data to our sponsors. Phreesia does not collect any patient identified information.  The information Phreesia does collect is network utilization for internal use only. 

(Editor's note: Earlier this year, Indig further clarified Phreesia's data collection procedures in an interview with eWeek.  According to the article:  "Phreesia can accumulate non-identifying information collected from patients for market research, but information is not tied back to an individual.  Indig also said that the company does not even provide information at the level of individual practices, which drug companies could use to dispatch drug salesmen. 'We're not selling any patient information. We're selling access to reach a patient,' said Indig.")
Q: I would assume that Phreesia is collecting information at some level to provide to companies who want to get information about who their info would be targeted toward.  Sponsors are pretty big on return on investment (ROI) and might even want to hone their messages based on the types of patients seen in certain regions of the country (or state).  Is it true that you are not collecting any data?  I would be surprised if you weren't.
A: Phreesia informs its sponsors who the Phreesia enabled practices are.  [This allows] the sponsors to analyze ROI however they see fit should they choose to do so.

Q: Are patients informed about what the data is being used for?  How are you addressing physicians' privacy concerns? 
A: Patients are informed that their data is used by physician’s staff. Physicians are not concerned as Phreesia is HIPAA compliant.


A company called Healthy Advice Network does something similiar to this company. They have pharmaceutical companies pay them perhaps a million dollars a year to tailor advertising messages on a suspended television in the doctor's waiting room about their promoted products. Their clients are listed on this company's website. Doctors who accept this service in their clinics should possibly be suspected of accepting inducements in general.

I would not recommend Phreesia to anyone. We can manually check in a patient in less than 3 minutes. These Phreesia pads take 18 - 30 minutes to check a patient in. Sometimes these Pads do not even want to connect. Tech support said to just restart them. We sometimes have to restart them 5-6 times before they start to work. Everyday we have to restart these pads multiple times a day. Patients get extremely frustrated having to go through many many many screens for a simple visit. Even repeat patients have to go through way too many screens. We contacted Phreesia to see if they would remove some of the screens. Phreesia support was less than helpful and said we couldn't remove any screens.

If you are a fast, efficient clinic/hospital then this product isn't for you.

If you are a slow clinic/hospital that make your patients wait 30 minutes in the waiting room, then this product is perfect for you.

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