The integration of a controversial online doctor service alongside Bunnings, Kmart and hundreds of pharmacies in the Wesfarmers portfolio has raised concerns among medical practitioners about potential risks to patient data security.
InstantScripts sprang to prominence during the pandemic, offering an alternative to the GP by generating prescriptions via an online form that was then remotely checked by a doctor. The business covers 300 low-risk drugs that patients can either pick up from a pharmacist or get delivered directly to their home.
The growth in such services prompted a crackdown earlier this year from the Medical Board of Australia, which argued prescribing medications in the absence of a real-time patient-doctor consultation was not good medical practice.
New board guidelines that came into effect this month require doctors to undergo a direct consultation, whether in-person or via video or telephone. If they don’t, they must explain “how the prescribing and the management of the patient was appropriate and necessary in the circumstances”.
Wesfarmers, which owns hundreds of Priceline Pharmacy and Soul Pattinson Chemist stores, spent $135m in July purchasing InstantScripts. While the online startup has previously generated up to $50m a year in revenue, the president of the Queensland pharmacy guild, Chris Owen, believes Wesfarmers would have seen additional value in the data being collected by the site.
He said the company would have siloing provisions to theoretically protect identifiable patient information, but even anonymised data could be very useful for online advertising, which is already largely based on stereotyped “personality sets”.
“They’ll still have the ability, if they join it together with their frequent flyer program or their flybys program … to have access to that data across a variety of different platforms,” he said.
“We’ve always held health data is pretty sacrosanct.”
InstantScripts’ general manager, Richard Skimin, said patient data was stored securely and accessible only by the company’s doctors.
“We apply the same principles to the handling of a patient’s health data as regular medical practices.
“InstantScripts’ secure systems are housed and managed independently, which eliminates any risk of a patient’s health data being inadvertently shared with other Wesfarmers businesses.”
However, the vice-president of the Royal Australian College of GPs (RACGP), Bruce Willett, said the recent PwC scandal showed major corporates were not always successful at maintaining clear boundaries between different arms of the business.
“[InstantScripts’] privacy policy says that they do share information for the purposes of targeted advertising and to their delivery partners,” he said.
“It says that they don’t share health information. But the question is: where is that line? And how effective is that [firewall]?
“We’ve seen examples of where that doesn’t work in other parts of corporate Australia.”
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Willett said regulators had not kept up with the fast pace of developments in the private sector, with vertically integrated medical organisations becoming increasingly common.
As well as prescriptions, InstantScripts also offers medical certificates for employees to take time off from work, specialist referrals, blood tests and other GP services, collecting information that could be of use to other Wesfarmers health businesses.
“This is probably the most extreme vertically integrated [arrangement] – from pharmaceutical suppliers to providing the prescriptions, providing the scripts, delivering the scripts, plus the other retailing things across to the side, with Kmart and what have you.”
Skimin said the medical board “missed an opportunity” in its revision of telehealth guidelines.
“There are certain cases in which asynchronous prescribing [in which doctors don’t consult in real time], when underpinned by robust controls and clinical governance process, works very safely and effectively,” he said. “Regulating such a practice out of existence is a clear example of provider interest taking priority over the interest of patients.”
The Consumers Health Forum of Australia’s chief executive, Elizabeth Deveny, said patients did have a lot to gain from the rise of telehealth – but it was also important to be careful, particularly around data collection.
“We also would call on the government to make better standards here with some plain English requirements, so that everyone knows straightforwardly what they’re getting consent for, and equally importantly, how they can change that over time,” she said.
“Sometimes what we see too is that you can only get the service if you agree to the data sharing.
“So we think that that clause should always be optional. In fact, we think you should have to opt in to anything like that.”