Peter Pronovost, M.D., a well-known patient-safety expert at Johns Hopkins University, has been named to the advisory board of DocuSys, a for-profit company that markets a wide range of high-tech services for hospitals, including an intravenous medication system that features bar coding and digital imaging to track drug delivery.
It's the most recent example of provider and insurance executives at not-for-profit organizations signing on to boards of for-profit vendors, a trend that has generated criticism among some governance experts about the appearance of conflicts of interest in these relationships. That criticism also has been leveled at doctors and medical researchers who supplement their income through consulting work with outside vendors, raising concerns that they may be blurring the lines between their responsibilities for patients and their roles in money-making ventures.
Pronovost, an anesthesiologist who is an assistant professor at Johns Hopkins University School of Medicine and the medical director of its Center for Innovation in Quality Patient Care, will advise the 5-year-old "digital medical solutions company" on a line of products centered on anesthesia services for hospitals.
Two fellow members of the DocuSys advisory board have worked for hospitals that do business with the Mobile, Ala.-based technology vendor. Last year, one of those physicians was named to the advisory board two weeks after the hospital where he worked as chair-elect of the department of anesthesia signed a contract with DocuSys.
Most hospitals and academic medical centers, including Johns Hopkins, have strict conflict-of-interest policies regarding employees' relationships with outside vendors. Pronovost is meeting the letter of the law, officials said.
Pronovost, in an e-mail response to questions, wrote: "My relationship has been reviewed by the Hopkins conflict of interest committee. As such, my role with DocuSys has restrictions." As to his reasons for joining the advisory board, he said he is "excited by the potential for (the company's) technology to improve patient safety." In the company's news release on his appointment in late July, Pronovost was quoted as saying that the kinds of electronic systems now being developed and marketed by DocuSys are "the next frontier" in patient safety.
Still, doctors who accept such paid positions at for-profit ventures should be wary of the slightest whiff of a conflict of interest, said Edward Bryant, a partner with the Chicago law firm of Gardner, Carton & Douglas and a Governance Institute faculty member who often lectures on the topic.
"It's the perception that counts sometimes more than the fact," Bryant said. "An apparent conflict is just as bad as a real conflict -- sometimes worse."
Members of the DocuSys advisory board receive compensation, including consulting fees and stock options in the privately held company, according to DocuSys spokeswoman Teecie Cozad. Robert Hanson, co-founder and president of DocuSys, declined to provide specific details about compensation for members of the advisory board.
DocuSys officials said they do not have any business dealings with Johns Hopkins. Hanson said DocuSys is working with Pronovost and "some other individuals" in Johns Hopkins' patient-safety foundation to "share product ideas and process." He said there is no formal business arrangement.
Pronovost dismissed any notion of a conflict of interest. In his e-mail response, he wrote: "I provide strategic advice on how their product can help to improve safety. (And) in some cases, how they should modify products. We have held brainstorming session(s) to discuss opportunities to improve safety."
Even in the absence of the slightest hint of a conflict, these relationships can sometimes pose problems and concerns. Earlier this year, John Forsyth, chairman and chief executive officer of not-for-profit Wellmark Blue Cross and Blue Shield, resigned as president of Iowa's Board of Regents after Wellmark became involved in a contract dispute with the University of Iowa Hospitals and Clinics, which are overseen by the state board of regents. In mid-February, Joseph Swedish resigned from RehabCare Group's board of directors about a month after he was named president and CEO of Novi, Mich.-based system Trinity Health. Swedish, who was appointed to the board just nine months earlier, remains on the board of Cross Country Healthcare.
Jerry Stonemetz, M.D., a physician who is the clinical associate and compliance officer for anesthesia and critical-care medicine at the Johns Hopkins Hospital, also serves on the DocuSys board.
Gary Stephenson, a spokesman for the internationally known academic medical center, said Johns Hopkins has "no business arrangements" with DocuSys, and that every faculty member at the academic medical center "must go through a formal written process" to ensure that these arrangements do not pose a conflict of interest.
Since it was formed in 1999, DocuSys has signed deals with 33 hospitals, with a threefold increase since the end of last year, Hanson said. The company, which has a total of 37 employees, has also formed partnerships with two well-established firms in healthcare information technology -- McKesson Corp. and Per-Se Technologies.
Two of the company's recent deals are with hospitals that employ or have employed members of the DocuSys advisory board.
Jeffrey Plagenhoef, M.D., chair-elect of the anesthesia department at Southeast Alabama Medical Center in Dothan, was named to the DocuSys advisory board on May 10 -- just two weeks after the company announced it had signed a deal with the hospital to provide an intravenous medication-management system. A spokesman for the hospital did not return calls seeking comment.
In the May news release distributed before his appointment to the advisory board, Plagenhoef was quoted as saying, "At Southeast Alabama Medical Center we want to take quality of care, patient safety and cost containment to the highest level. We are confident that implementation of the DocuSys and DocuJet technology will assist greatly in achieving our goals."
Also, in March 2004, Matthew Weinger, M.D., a staff physician at the San Diego Veterans Administration Healthcare System, was named to the DocuSys advisory board.
Nine months later, in early December 2004, DocuSys announced that it had installed its anesthesia information system in six operating rooms and the pharmacy at the San Diego Veterans Affairs Healthcare System, with more installations planned for two cardiology catheterization suites.
Terry Jemison, a VA spokesman in Washington, said Weinger was a part-time staff physician at the facility for about eight years until his voluntary resignation in February. He said the doctor disclosed his association with DocuSys and had no involvement in the contract.
Hanson said neither Weinger nor Plagenhoef was involved in their hospitals' decisions to sign deals with DocuSys.
This story was originally published in the Aug. 8 issue of Modern Healthcare.