KwikMed

Introduction

October 16, 2001 - KwikMed was purchased by Peter Ax, managing partner of Phoenix Capital Management (PCM). Peter Ax was formerly senior vice president and head of private equity at Lehman Brothers where he was responsible for the institutional private placement of late stage venture capital financing. The previous owners of KwikMed were criminally prosecuted for writing prescriptions on the Internet without a valid physician and for illegally repackaged medications obtained from a drug wholesaler.

The cornerstone of KwikMed's health delivery system has been the creation of advanced software which takes a complete online medical history of the patient by asking specific questions of the patient. Depending upon how the patient responds, additional questions may be asked. All of the patient data collected during that online interview is compared to standardized medical scales to see if the patient is an alcoholic, is suffering from a mental illness, smokes too much, has an aggressive personality, etc... All of this information is collected by KwikMed physicians who then make a determination to 1) treat the patient with the patient requested medication, 2) suggest alternatives therapies for the patient, 3) collect additional data by email or phone call, 4)that the patient must be treated in a face-to-face setting and not allow any prescription to be written for this patient.

Time line

Regulatory movement

Since 2001, Peter Ax and KwikMed have been involved in the development of regulatory standards for online pharmacy safety. Through discussions with physicians, medical experts, state and federal legislators, and regulators, KwikMed has developed a version of an electronic medical record and patented online medical assessment software that has become a standard for the online prescribing of medications. Recently enacted Utah legislation codified KwikMed business practices in what has become the standard for states wanting to enact legislation to regulate and protect its citizens. In 2010 Utah passed the Online Prescribing, Dispensing, and Facilitation Act [1]. The audio version of the Utah state legislature hearing is also available [2] online.

The first face to face meeting between and among PCM, its counsel, members of the Utah DOPL and representatives of the Utah Attorney General's office took place in February 2002. During this meeting the following was established -

Utah DOPL and PCM enter into The Utah Consent Order in December 2002. The Consent Order required KwikMed (PCM) to design and implement an appropriate interactive medical assessment tool to be used by website users to ensure that each user provides a complete detailed medical history and physical evaluation sufficient to enable PCM's contract physicians to establish a diagnosis and to identify underlying conditions and/or contra-indications to the treatments recommended by those physicians. By the terms of this agreement, PCM was required to secure the DOPL's approval before any additional drugs could be prescribed and dispensed via the website. These medications included the erectile dysfunction medication Viagra and the male pattern hair loss medication Propecia. Although DOPL originally granted approval for PCM to dispense the weight loss drug Xenical and the arthritis medication Celebrex, PCM later asked to have these two removed from its approved list of drugs based on PCM's concern over the safety of these medications. Later, two addition erectile dysfunction medications, Cialis and Levitra, and the smoking cessation medication,Chantix, were added to the list of approved medications for PCM to distribute with a valid prescription.

Additionally, by entering into the Consent Order, PCM agreed to allow the DOPL representatives to access PCM's contract physicians and pharmacies to inspect medical and pharmacy records, as permitted by state regulations.

University of Utah research as listed in Mayo Clinic Proceedings

In August 2008, the Mayo Clinic Proceedings vol. 83 no. 8 issue included published the findings of research conducted at the University of Utah. This research compared KwikMed's model for the online delivery of healthcare to more traditional interactions between physicians and patients which typically take place in a face-to-face office setting.

The following researchers took part in the study: Mark A. Munger, PharmD; Gregory J. Stoddard, MS; Allen R. Wenner, MD; John W. Bachman, MD; John H. Jurige, MD; Laura Poe, RN; and Diana L. Baker, RN.

The objective: to discover if an online medical consultation could diagnosis and treat erectile dysfunction as safely as a traditional face-to-face visit with a physician.

The study was designed with by comparing electronic medical records. 102,734 of these records came from KwikMed and 110,000 were the University of Utah multidisciplinary primary care systems records. The study then consisted of 500 stratified random sampling of e-medicine records.

Statistical analysis

Demographics, medical history, drug history

Safety comparisons

Unmatched samples (balancing groups)

Results

Physical examination

Median: < 1 year

ED prescription outcomes

Results

Conclusions

1. First independent, comprehensive study of a regulated Internet prescribing system
2. The e-medicine system matches or exceeds all traditional medical practice in all aspects of patient safety
3. State regulatory agencies should consider licensing Internet prescribing companies