The pMD Blog

Image: BSIP/UIG via Getty Images

Here's The Latest in Health Care:

• As part of the Cancer Moonshot Task Force, the NCI (National Cancer Institute), Amazon Web Services and Microsoft teamed up to create an online repository for genomic data. The hope is to be able to improve the care and understanding of cancer by allowing the cancer medical community to have the best possible resources and tools available. By building a sustainable model to maintain and share cancer genomic data, researchers will be able to easily and securely mine stored data. Read More

• Lunacy and chaos run amuck, come November 14 and December 14. At least that's what some doctors and medical staff across the country are preparing for when the full moon strikes on these nights. Many hospitals actually beef up their staff in anticipation. The theory is that because our bodies are 70 percent water, the moon that moves the oceans may also move the water in our bodies, causing psychotic episodes. Read More

• The CDC (Centers for Disease Control and Prevention) reported this Wednesday that people infected with gonorrhea, chlamydia and syphilis are at an all-time high, hitting teenagers and young adults the hardest. Major drivers for these increases are tied to STD care and prevention programs being cut due to state and local budget cuts. Read More

• Rural hospitals outperformed urban hospitals in value-based programs in 2015, according to a report released Wednesday by the U.S. Department of Health and Human Services. Some areas in which rural hospitals did very well were patient experience metrics and succesful fostering of care coordination. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

With health care shifting from volume-based to value-based care, there is heightened focus on patient outcomes and providing quality patient care. Since the HITECH Act passed in 2009, there has been an increase in incentives for providers to participate in quality programs, such as Meaningful Use. These incentives, and penalties, show no sign of slowing down anytime soon. One initiative we’ve been hearing a lot more of lately is PHM, or Population Health Management. Like most buzzwords in health care, there’s a lot of excitement around the possibility of implementing a successful PHM program, but what does that look like in practice? First, it’s important to understand what PHM is, the challenges around PHM, and some steps we can take to move us in the right direction.

So what is Population Health Management? PHM seeks to improve the clinical and financial outcomes of a group, or population, by using patient data from multiple health care resources and analyzing that data into a single patient record. In short, PHM seeks to help chronically ill patients get better, while also decreasing the amount of money spent on patient care. In order to successfully implement a PHM program, it’s important to define your population. Typically, population health focuses on identifying the sickest patients and usually those with chronic conditions. Sadly, these sick patients shouldn’t be hard to find: as of 2012, 117 million people, about half of all adults, had one or more chronic health conditions. 25% of adults had two or more chronic health conditions.

While there are certainly enough chronically ill patients for health care organizations to target through a health management program, PHM does not come without challenges. For one, interoperability in health IT has its limitations. Many EHR systems do not communicate with one another, so if a patient is admitted to a hospital that uses one EHR system, and then that patient sees their primary care physician who uses another system, that patient record becomes fragmented. In other words, we rarely see the same intelligence tools (EHRs, PMs, etc.) used across multiple organizations. And when data across different systems is collected, how can we transform these inputs into one streamlined output? Additionally, while we certainly have a large pool of patients to select for PHM programs, patient compliance is often outside of the control of a provider or health care organization.

Even with the above challenges, PHM is not futile and are things we can do to steer us in the right direction. Care coordination, a huge focus here at pMD, allows physicians to coordinate care across multiple organizations, leading to improved transparency into that patient’s health care journey. A great example of this is the AIM program in Anchorage, Alaska. In addition to connecting care communities, interoperability must become a reality if PHM is to succeed. Interoperability refers to the ability for different health systems (EMRs, practice management systems etc) to exchange and share information. Lastly, getting patient involvement and buy-in is tremendously important when we talk about improving outcomes in PHM. Medication compliance, engaging in online patient portals and patient education are all ways medical professionals can encourage their patients to become involved in their health outcomes.

The shift from fee-for-service to value-based care is certainly a refreshing change, and one in which pMD is prepared to help. pMD encourages communities of physicians to communicate through our secure messaging platform to ensure continuity of care from hospital to PCP. Improving outcomes for patients has obvious benefits for all health care stakeholders. As a matter of fact, improving prevention and disease management for chronic illnesses, such as diabetes and heart disease, could save the US over $1 trillion by 2023! While value-based care is still a work in progress, programs like PHM are moving us in the right direction.

Image: Photo illustration by Joe Raedle/Getty Images

Here's The Latest in Health Care:

• Kratom advocates can breathe a momentary sigh of relief since the Drug Enforcement Administration recently withdrew its notice of intent to classify the kratom plant as a Schedule I substance. Kratom is derived from the leaves of a tree native to Southesast Asia and is most commonly used in the U.S. for coping with chronic pain. The DEA attributed 15 deaths to kratom between 2014 and 2016. The public comment period ends Dec. 1st after which the DEA could still decide to temporarily ban kratom or place the plant in a scheduled category, permanently.  Read More

• As the number of Medicaid enrollees continues to grow, most states will tighten controls on spending in anticipation of next year's reduction in federal aid. Strategies to contain costs include hiring private managed care companies to deliver services to enrollees and restricting use of pricier prescription drugs.  Read More

• CMS will soon release the final rule that will result in major changes in how physicians are paid under Medicare. Physicians and organization leaders are worried that the new rule, which will implement the Medicare Access and Chip Reauthorization Act (MACRA), will hurt small practices and cause rifts between primary care doctors and specialists. MACRA will incentivize top-performing doctors and ding under-performers based on a variety of measures. Read More

• A heater-cooler machine, which is a device used during open-heart surgery, was found to have been tainted after 12 patients at a Pennsylvania hospital were infected last year. The device originated from a plant in Germany. It uses water to regulate the patient's temperature during surgery. While the water does not come into contact with the patient, bacteria can be transmitted through the air from the machine's exhaust vent. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

Image: FierceHealthcare

Here's The Latest in Health Care:

• Both commercial ACOs (Accountable Care Organizations) and non-commercial ACOs are lagging in critical IT infrastructure that will help improve the cost and quality of care. Commercial ACOs still outperform their non-commercial counterparts in both cost and quality of care but significant technological improvements need to be considered, more specifically in interoperable capabilities. Read More

• Donor organs from drug overdoses are considered high-risk but due to the recent surge in deaths from drug overdoses, these organs have become a life line for transplant patients. The risk of transplanting an infected organ is small and diseases like hepatitis C can be treated or cured, and in severe cases such as HIV, can be managed. The chance at prolonging life with an infected organ in the face of death is a silver lining to those waiting for a transplant. Read More

• Researchers at the University of Michigan School of Medicine and Brigham and Women's Hospital in Boston found that there is a wide variation of medicare costs associated with post-op complications. They also found that the costs can vary from hospital to hospital. Previous research suggested that high-volume, lower cost facilities tend to have lower associated post-op costs and better outcomes than more expensive hospitals. Read More

• Congress directed $394 million to the Centers for Disease Control and Prevention to fund Zika response efforts. Funding for efforts to improve diagnostic tests and expand lab capacity play a big role in being able to provide a quick turnaround for women getting tested for the disease. Currently, test results can take more than 4 weeks. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
How being a pMD intern doesn't mean doing coffee runs.

For the past three months, I’ve had the pleasure of interning at pMD in their San Francisco office as part of their engineering team. Over the course of the internship, I’ve learned about the field of health care, improved my development skills, worked on some really cool projects, and, most importantly, come to know the pMD team. The summer flew by and now as I wrap up my internship, I’ve had a chance to reflect back on my time here.

When I joined pMD, I was placed on the “Goatworks” team - a sort of subteam within the engineers that focuses on special projects. Throughout the summer, I worked closely with my manager and mentor, Clayton, the Lead Software Engineer on that team. In addition to weekly chats about anything that was on my mind, Clayton suggested books that helped me improve technically, guided me through each of the projects I was assigned, and gave me advice on career development. I think that having such a great mentor as the “go-to” whenever any questions came up was one of the keys that made this internship special. But Clayton wasn’t alone in his mentorship; the entire development team acted as teachers at different points during the internship. Whether it was talking through architecture decisions, pairing up to work through a tough problem, or just grabbing lunch, the team supported me throughout the summer and the collaborative environment helped me to be more productive and have more fun!

Over the course of the internship, I was able to create a new version of the app for Primary Care Physicians, fix various bugs, add new features on both the web and iOS, and add filters to the report section of pMD where administrators and supervisors can gather valuable data on their practice with ease. I also worked on patient tagging and custom field filters that allow doctors to see groups of patients with specific attributes.

The technical project I am most proud of is the ability to securely message with patients using pMD’s HIPAA-compliant messaging product. The project was a little intimidating as it spans across every platform and touches many different aspects of the codebase. But with the support of the pMD team, I felt confident in tackling it. Taking this project from the design stage to a beta version was a long process, but it has also been very rewarding. Being able to experience the development process in its entirety - from the idea stage all the way through to the final release and seeing your work live - is an incredible feeling.

Throughout the summer, I felt like my opinion was appreciated and I felt like a full-fledged member of the team. I found that pMD’s culture is very people-centric. Every person I’ve met at pMD understands that improving real people’s lives is at the core of what we do, and this core value shines not only through our amazing customer service, but also through how the company treats its employees. pMD cares about their employees and invests in their success, and each employee is passionate, motivated, and hardworking.

Since we’re a small team with customers all over the country, employees travel often. I was lucky enough to join the team on a trip to Anchorage, Alaska, and it was during that trip that I got to know many of my colleagues. While we hustled every day to make sure we could see as many of our customers as possible during the trip, the team also took time to hang out and have fun in the evenings, whether it was hiking to a glacier, sharing a delicious meal, or riding a mechanical bull.

The internship program at pMD is unique because it is customized to the individual’s strengths, interests, and experiences. I’ve been surprised by how much I’ve been able to contribute in such a short time thanks to the mentorship of the development staff and how much fun the work has been. pMD gives you the best of both worlds: a nimble, lean, startup that’s moving and growing quickly and the security that comes with a business that’s established (and shipping!) for over a decade. For any prospective interns, pMD should be on the top of your list.

Carrying a smartphone or wearing a fitness tracker has allowed millions of people to track their steps, heart rate, calories, and more. The opportunities for this data to be used between doctors and patients is growing with new technological developments. In a perfect world, that information could even be sent to your doctor, making your appointments more effective and efficient.

That perfect world isn’t too far away with the recent release of Apple iOS 10. Previously, you had the ability to export health data captured in your phone, but it wasn’t very clear whom you would send this this to and how.

Apple will be releasing the groundwork to allow its users to more easily send and receive information from their iPhones to their doctors' electronic health records. This type of transfer of information between providers and patients will empower and engage patients in a kind of way we haven’t seen before. Apple plans to do this through their HealthKit functionality, which all iPhones already have. HealthKit is a set of services that enable application and device developers to securely measure, manage, and store health and fitness data. HealthKit also allows data from physical devices to be incorporated, so your FitBit or Apple Watch's data can be sent to your doctor. After you visit your provider, they can add any updates and send you your updated medical record which you can take with you.

Patients will also have the ability to receive their medical records on their iPhones. Currently, patient access to their own medical records is a hotbed issue due to the fact that so many patients lack access to begin with. Apple’s new functionality will empower and engage patients across the country. You might be wondering how Apple’s HealthKit will be able to send this information back and forth from the doctor’s EHR to the patient’s iPhone: It is through Clinical Document Architecture (CDA) and Continuity of Care Documents (CCD), which are now supported by HealthKit. When you look at a raw CDA or CCD document, the data probably doesn't make sense to most people. But when health documents are sent in the format of a CDA or CCD, they can now be received by HealthKit and then converted into readable data via your EHR’s mobile app.

This type of technology will allow patients to play a bigger part in their own care team, and more specifically, own their health information. While this is an exciting step in the right direction, patients will still need a secure way to actually send and receive sensitive the health information. Doctors will not be able to simply send you a text with your health record or vice versa. There needs to be a tool allowing you to communicate directly with your providers.

pMD is developing a secure text messaging feature that allows its physician users to safely and easily communicate with their patients. This can complete the missing piece to the puzzle, allowing patients to freely request and receive their health data and become more engaged in their health care. Stay tuned for more updates from pMD!

Image: FierceHealthcare

Here's The Latest in Health Care:

• A new report from the ECRI institute found that patient-identification mix-ups in health care organizations is a much larger issue than previously thought and can lead to deadly consequences. Cases of patient identification errors included administering incorrect medications, not resuscitating a patient who did not have a DNR order on file, and an infant given breast milk from the wrong mother. The report urged all health care facilities to adopt a standardized protocol to verify patient identities. Read More

• An agency within the Department of Health and Human Services on Wednesday issued a rule that prevents any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court. Millions of elderly Americans across the country will be afforded new protections and be able to take disputes to court more easily. It is the most significant overhaul of the agency’s rules governing federal funding of long-term care facilities in more than two decades. Read More

• The Food and Drug Administration approved the first artificial pancreas on Wednesday, allowing patients with type-1 diabetes to hook up the device and skip the routine finger pricks to check their blood sugar. Many groups are working on similar systems aimed at alleviating diabetes patients of constantly having to check their blood sugar and delivering insulin. Read More

• Six health systems will test new federally-approved and winning designs for an easy-to-understand medical bill aimed to improve the patient billing experience. The Department of Health and Human Services challenged the health care and tech industry to develop a medical bill that’s easier for patients to understand. Complex medical bills are a major obstacle to both patient satisfaction and the collections process, as they tend to contain insider jargon that leaves patients confused as to the amount they owe and why. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
I recently gave my "How to Build Learnable Apps that Users Love at First Sight" tech talk at Brown University for the fourth time. This is a fun one because most people haven't thought much about what makes software easy to learn, so there are usually at least a few "aha!" moments.

If they've considered it at all, computer science students generally think of usability in terms of "counting clicks" - how many steps it takes to perform an action - which is indeed important, but doesn't necessarily make the software easier to learn for a new user. Even if it only requires one step to do what you're trying to do, that doesn't help you if you can't find the button!

You only need to click one button, but can you find it?

My talk describes three "laws of love" - principles that can make software more learnable and intuitive for new users. They are:

1. Love starts with what you know. Most people who use your software have used other software before. Rather than starting from scratch with your user interface, use elements that are familiar to your users: a search box in the upper corner, icons that are similar to those in other apps, and native buttons and widgets whose purposes will be obvious because they come from the user's device. Familiarity makes it easy for users to learn your app because their guesses are good.

2. Love makes complicated choices simple. People feel overwhelmed and confused when presented with too many choices. Even extremely complicated software such as Google Search and Siri can give the user a very simple and obvious way to interact with it. If you only have one choice, you can’t make the wrong choice.

3. Love is spontaneous! New users naturally feel trepidation when trying things for the first time, so what happens when they're starting to click around is extremely important. Are they rewarded with a delightful feeling of competence ("I am a genius!"), or punished with unintended side-effects that can't be undone? Like a game that starts on beginner mode, does your software build up the user's mastery by starting with the basics and then gradually offering them more tools, logically building on what they've learned?

This is a very simple user interface that nonetheless discourages trial and error.

Finally, after following the principles above, one very important step remains before releasing your app to users: test the design! Software engineers have figured out some very powerful tools that allow you to analyze your users' behavior from afar, such as A/B testing and heat maps. But you can't rely on this analytical data alone if you're trying to create an emotional feeling (love) in your users. Heat maps won’t tell you “are you feeling frustrated while trying to figure out this screen?” A/B testing won’t tell you “what were you hoping would happen when you tapped on that button?” These are helpful tools, but they aren’t substitutes for understanding your users.

If you want your users to get engaged with your app, you have to get engaged with your users. Watch them learning the app for the first time and pay careful attention. Facial expressions, body language, and tone of voice will tell you things that the user could never or would never articulate.

Better yet, be a user yourself and force yourself to rely on your software - this will make it harder for you to miss or ignore its flaws. Your app will be 1000 times better and you’ll learn how to design great software. There are many paths to success in software, but the surest is to create mind-blowingly amazing software that your users love.

Around this time last year, many medical practices were feeling pretty stressed out; there was a lot uncertainty around the ICD-10 transition. What was going to happen on October 1st, 2015? Would claims stop being paid? Did practices need to set aside funds to keep their businesses afloat? Would the payers be ready? Was an ICD-10 code for a "burn due to your water skis catching on fire" (V91.07) or "getting hurt at the opera" (Y92.253) really necessary?

October 1st, 2015 came and went, largely without a lot of incident. Practices started using ICD-10 codes (to varying degrees), and much of the gloom and doom that was predicted seemed to never come to pass. A lot of this was due to the one year ICD-10 "grace period” that CMS put in place, which stated that they would not deny claims as long as the ICD-10 codes used were in the correct family of codes. This grace period that has been so helpful in easing this transition is coming to an end at the end of this week, and practices are starting to brace themselves.

Some of the most common questions we’ve received from practices that we work with are listed (and answered!) below.

What is changing on October 1st?
The period of “ICD-10 flexibilities,” or the ICD-10 grace period, is ending. CMS will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when a specific one is warranted by the medical record. CMS is also removing 305 existing ICD-10 codes and adding 1,900 new codes (this number is much higher than most years due to a coding freeze).

What’s a real example?
During the grace period, in order to bill diagnoses for Hodgkin’s Lymphoma, for example, providers were able to choose from the family of C81 codes, including the most general code, “Hodgkin’s Lymphoma, unspecified, unspecified site (C81.90).” This code would have been accepted by CMS even if the clinical documentation supported a more specific code. After October 1st, providers will be required to be more specific, using codes like “Lymphocyte-rich classical Hodgkin lymphoma, spleen (C81.47)” that describe the nature of the lymphoma and the body part.

Will these flexibilities be extended or phased in?
In new guidance released at the end of August, CMS states that the ICD-10 flexibilities will not be extended past October 1st, 2016, and will not take a phased approach to coding at the highest level of specificity.

Can I still use an unspecified ICD-10 code?
Yes, but only when the clinical documentation does not support a more specific diagnoses.

What can I do to prepare?
Run historical reports to identify the usage of unspecified and header codes over the past year. If there are unspecified or header codes that are used in high frequency, work with providers to identify other options to replace those codes when the documentation supports a higher specificity.

It may end up that October 1st, 2016 is a much more important date to remember than its predecessor a year ago. Many practices are gearing up for the denials and rejections that could be coming their way, and searching for ways to educate their providers on these new, stricter rules.

Here at pMD, hospitals and medical practices have been utilizing ICD-10 prompts within our electronic charge capture software. This feature proactively asks providers in real-time for more specific information when selecting an ICD-10 code that requires it. While no one really knows what type of crackdown CMS is going to employ later this year, our customers have put their trust in us to be forward thinking and give them the tools they need to make sure they are compliant.   



Here's The Latest in Health Care:

• A new study from the University of Pittsburgh found that wearable technology does not necessarily lead to more weight loss. In a study that enrolled 470 people of varying age and BMI, the mean weight loss for the group using wearables was 7.7 pounds while the group that did not use wearables lost a mean of 13 pounds. There is more to learn about how these devices impact behavioral change. Read More

• Curavi Health, a new startup in the telehealth industry, enables physicians to remotely interact with their patients and nursing home staff via proprietary software and equipment. Nursing home patients are often transferred to hospital emergency rooms unnecessarily due to lack of proper medical advice to their nurses, driving up medical costs and causing more harm than good to the patient's health. Read More

• Despite improvements in health care, the U.S. maternal mortality rate has risen while the global death rate fell by more than a third from 2000 to 2015. Some researchers argue that the increase is a result of rising ailments such as heart problems and other chronic conditions, like diabetes, in the population. Other factors, such as increased pregnancy rates in older women, better tracking of maternal deaths and even racial disparities have been theorized. Read More

• The ongoing EpiPen saga continues as Mylan CEO, Heather Bresch, met with members of Congress yesterday to testify in response to the unprecedented, six-fold price increase of the life-saving EpiPen auto-injectors and the political firestorm over pharmaceutical profitability. Bresch claims that after rebates, fees and other related costs, the company reaps a profit of $100 per two-pack, attempting to squelch any misconception surrounding the company's high profit margin from the EpiPens. Still, analysts say the margin is quite high. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.