Commercial Influences on Electronic Health Records and Adverse Effects on Clinical Decision Making

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.