The pMD Blog

Welcome to the
pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

Here's The Latest in Health Care:

•  The nonprofit Physicians Foundation has started a program to financially incentivize physicians to link their electronic health records to health information exchanges (HIEs). The Foundation is partnering with six state medical societies in an effort to facilitate the sharing of and access to interoperable patient data. The number of EHRs and other systems physicians are required to use is one of the leading causes of burnout. This initiative has the potential to improve data sharing while reducing the burdens currently faced by physicians and patients.  Read More

•  According to a new report from The Leapfrog Group, patients at hospitals that received “D” and “F” grades in safety were 88% more likely to die from medical error compared to those treated at higher scoring facilities. Although the death rate from medical error has improved over time, decreasing from 205,000 avoidable deaths in 2016 to 160,000 in 2018, these statistics are alarming to researchers. Some people criticize Leapfrog’s rating system as being too simple and potentially deceptive, although the CEO defends the program, citing that the results are based on actual death rates and real occurrences of medical error.  Read More

•  Research in brain-stimulation has seen many recent developments, including the creation of electric current skullcaps to enhance the memory of older people and electrode skull implants that boost memory storage. The current knowledge about brain stimulation recognizes that there are many different techniques, applications, and unknown risks that come with it. Electrical intervention therapy has been used for many years to provide relief for depression and manage intense medical conditions such as Parkinson’s disease. Brain stimulation studies have been groundbreaking and intriguing, although they have had their share of controversies and still reveal many mysteries to uncover about the human mind.  Read More

•  The United States saw a 2% drop in birth rates from 2017 to 2018, the lowest number in 32 years. Demographers had predicted the birthrate to stabilize or increase due to the growth in the U.S. economy and job market but instead were surprised by the declining birthrate, calling it a “national problem.” Some researchers cite factors such as the increase in Americans who are delaying getting married and having children and an overall negative outlook for the future from those of childbearing age.  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. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, and care navigation software.

Here's The Latest in Health Care:

•  A study from the American Medical Association has found that for the first time since this survey was conducted in 2012, the percentage of employed physicians outnumber self-employed physicians. The findings confirm a continuing trend of declining physician ownership of medical practices due to the administrative burden of health care reform and decreased reimbursement.  Read More

•  A recent study, published in the journal PNAS, provides new evidence of a single gene that determines how different one person's "smellscape" is from another's. The scientists who conducted the study found that the single genetic mutation was linked to dozens of scents including the lily of the valley scent, beet’s earthiness, and the intensity of whiskey’s smokiness.  Read More

•  A new experimental genetic test that can help predict obesity has the scientific community questioning whether a deep dive into DNA databanks is valuable, especially since there is currently no clear way to put that information to use. This type of analysis performed in this study doesn't reveal specific information about individual genes, instead calculating a composite score, and can't be used to understand one’s underlying biology. Some researchers have concluded that while genes influence a person's risk of obesity, the obesity-promoting culture sweeping the nation is far more impactful than being at genetic high risk.  Read More

•  A new study shows that more hospitals and health systems are recognizing the innovation that nurses can bring to their organizations. According to the report, nurses are appreciated by their colleagues for skills in areas such as the "interface of clinical innovation and technology" and "design-thinking for process change.” While this appears to be increasingly true, many health system leaders recognize the need to have more nurse innovators at the leadership level and recognize the forward-thinking skills nurses can contribute to product and process development.  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. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, and care navigation software.

Customer interactions article

Don't trust a mirror that only tells you how wonderful you look.” ― Matshona Dhliwayo

I remember playing softball as a kid, obsessively working on my swing. It’s all about your stance, the way you hold the bat, and timing. I would practice and swing the bat one hundred times over, but what I always needed was another perspective, someone to watch and tell me what I could fix.

As someone who has worked in customer service over the last few years, I’ve learned first-hand how customer interactions can serve as an outside perspective that companies need.

Product Support a Primary Customer Interaction Channel

pMD’s customer support is one of the primary channels in which we interact with our customers. Not only do we provide 24/7/365 support to help solve any issue or answer any questions pMD customers might encounter, it’s also a way to gauge how our products are creating value and what things we need to focus on as a company to make pMD even better!

Product Feedback Process

Here at pMD we “eat our own dog food,” meaning we use our own product on a daily basis (we don’t actually eat dog food). This gives us pretty good insight into what is, and sometimes isn’t, working properly. Even with that said, hearing from our customers who use pMD in their medical practices allows us to gain further insight into areas of improvement and innovation. The pieces of feedback they give us are like little nuggets of gold for debugging, making adjustments, and enhancing product features. We have a process for receiving this feedback and doing our best to ensure nothing is overlooked or falls through the cracks:

1) First, product feedback is received by a pMD employee via various channels of interaction with our customers, such as support, training, implementation, or account management

2) The request or idea is submitted as a ticket to our product team for review.

3) The product feedback request is triaged based on answers to the following questions:

•  How immediately can change be implemented?

•  How many users will be positively impacted?

•  How much time will this save our users?

•  Will this improve our security?

•  Does the update make our products easier to use?

Charge Capture Product Feedback in Action: New Feature for Nephrology Billing Teams

Most new product features and updates that we release are driven by the feedback we get from our customers. If the request identifies a specific need and the solution will positively impact pMD’s user base, then the request has a good chance of making it on to our product roadmap.

We recently released a new feature that helps our charge capture customers' nephrology billing teams stay organized and save time by automatically batching Monthly Capitation Payment (MCP) dialysis visits, where they can then be appropriately processed at the end of the month. This enhancement was a direct result of customer feedback; through various account management meetings and support encounters, we learned that many nephrology billing teams were spending a disproportionate amount of time manually sorting and organizing their monthly dialysis visits. We worked with these customers to understand the issue at hand and determine how to best implement a change that would be most impactful, ultimately resulting in a new feature now available to all of our nephrology practices.

To put it simply, the relationship we have with our customers is symbiotic. We strive to make a product that creates value for our customers, and in return, we truly value the feedback that we receive from them. While it's great to have a mirror that tells us how wonderful we look most of the time, we also appreciate when we receive feedback on how we could be better!

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:

•  New research is asking the question: can treating patients with both medicine and compassion make a measurable difference on the wellbeing of both patients and doctors? A recent study has shown that when health care providers take the time to show compassion and make human connections, patient outcomes improve, medical costs decrease, and physicians suffer less burnout.  Read More

•  The Department of Health and Human Services issued a request from December 2018-February 2019 for the public's input on how the HIPAA Privacy Rule could be changed to further promote health care that is better coordinated at lower cost. HHS requested this information on specific HIPAA regulations that present barriers to patient care and interoperability. The office said it wants to update HIPAA to support care coordination, improved patient outcomes, and easier access for patients to their protected health information. The AMA later posted a letter saying that this wasn't necessary and urging HHS not to make changes.  Read More

•  A recent United Nations report says that the overuse of common antimicrobial drugs is leading to the world’s population becoming unable to fight deadly infections. The problem is predicted to majorly impact underdeveloped countries, which are more prone to the spread of infectious diseases. The report seeks to raise public awareness and urge political leaders to take action.  Read More

•  Cincinnati-based health system Bon Secours Mercy is planning on yet another merger - this time in Ireland. The new partnership will create a system with more than 60,000 employees and improve care for their patients and communities. These new merger talks with Bon Secours Ireland comes only months after Bon Secours and Mercy Health finalized their merger, which resulted in a whopping $293 million in operating income.  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. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, and care navigation software.

Secure HIPAA-compliant Communication

Lately, it seems that more and more health care providers are increasingly interested in secure communication and the different platforms available to them. These providers and their support staff want to improve communication at their practices while still remaining HIPAA compliant.  

As a member of our sales team, I’ve had the opportunity to speak with many of the interested practices who reach out to pMD to learn about what we have to offer in this space. pMD has two different communication products: our Free Secure Messaging and our more robust Clinical Communication option. If you just did a double take to see if you misread “free,” no, you were not mistaken!

Are you curious about when our free option is the best fit for a user or when they might benefit more from our paid option? Continue reading to learn what I listen for when I speak with potential clients and help them decide which product will best suit their needs!

When I have the opportunity to speak with someone who is looking into the options they have for secure messaging, the first question I ask is, “What are your needs, and how many people do you need to message?” If the prospect tells me, “My colleague and I want to be able to message with each other about PHI (Protected Health Information) on our phones while remaining HIPAA compliant,” that is generally a cue for me that they have fairly simple needs and are most likely a good fit for our more basic Free Secure Messaging. Generally, groups with under five users that need to communicate basic information in a HIPAA-compliant and streamlined fashion are a good fit for our free product, and I suggest that they go to the App Store or the Google Play store and sign themselves up for pMD’s Free Secure Messaging. They can then get started right away!

I also often speak with groups who tell me about how much time they’re wasting trying to keep PHI out of their text messages by using cryptic symbols or hieroglyphics, and they end up having to just pick up the phone and call to find out who and what the message is even about! They recognize that they’re wasting even more precious time in their busy schedules and want a better solution that reduces inefficiencies. For larger groups who have complex workflows and more users needing to communicate about patients or securely send PHI, I suggest they evaluate our Clinical Communication product. Clinical Communication users can securely message using pMD on either their mobile device or the website, so they can stay compliant whether they’re on the go or stationed in front of a computer. pMD Clinical Communication also includes patient-centric messaging, allowing users to store a variety of information and message history. This removes the need to search through hundreds of messages to find one specific conversation with Dr. Smith about patient John Doe’s condition three weeks ago.

Another great use case I often hear is the need to message with patients. This is a feature of our Clinical Communication product, which allows users to easily send messages to their patients while keeping their health information secure.

pMD is always innovating and working to meet the needs of our customers. We very recently released our new Video Chat function, so if you prefer a more face-to-face interaction with your colleagues, feel free to give it a try!

We hope that by allowing providers to communicate in a more streamlined and efficient fashion amongst themselves and their supporting staff, we can give them back more time to be doctors and provide care to their patients.

If you’re interested in learning more about our Free Secure Messaging or Clinical Communication products, please submit your information here and we’re happy to help you evaluate which product would be the best fit for you! Don’t miss out on our signature text tone: the goat squeal!

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:

•  Recent studies show that time spent on smartphones impacts sleep, self-esteem, relationships, memory, and more. The use of our favorite devices can also cause elevated levels of cortisol, the body’s main stress hormone. Increased stress levels can have dangerous effects, including an increased risk of serious health problems and a shorter lifespan.  Read More

•  On April 19, CMS proposed increasing payments to skilled nursing homes by 2.5% in 2020. This new structure for the SNF Value-Based Purchasing Program will calculate Medicare payments based on the patient’s condition and care received, rather than the amount of care provided, more closely aligning with value-based care models.  Read More

•  The FDA has approved an AI-powered wearable device that patients can use to track multiple vital signs, including heart rate and oxygen saturation. Clinicians can receive real-time updates with highly accurate analytics, allowing them to monitor patients’ health and intervene when needed. The company has partnered with large health systems worldwide to assist in delivering home health care, aiming to decrease readmissions and preventable deaths.  Read More

•  Social factors such as food security and access to transportation have been proven to impact health. Health systems are trying to address patient populations struggling in these social and environmental areas to deliver successful care and improve patient outcomes.  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. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, and care navigation software.

The vision and realization of interoperability in health care IT has been evolving and manifesting - slowly - over many years. Significant progress has been made in technology, health care policy, and the mindsets of the people and parties involved. In 2019, we are witnessing an invigoration around the topic, and here at pMD, we are excited to be a part of it.

New Rules Surrounding Interoperability in Health Care IT

In February of this year, the U.S. Department of Health and Human Services (HHS) proposed new rules surrounding interoperability, which aim to improve electronic access to health information. The rules will require the industry to implement standardized application programming interfaces (APIs) that enable electronic health records (EHRs) and other health care technologies to integrate and transfer electronic health information (EHI) between them by 2020. The rules also require that patient electronic access to this EHI be made available at no cost. These rules are not only directed at providers, but also payers, who must make their data available to patients and Health Information Exchanges.

This is great news! But before we drink the newest flavor of interoperability Kool-Aid, let us be aware that the call for patients’ access to their medical record has been sounding for many years. Back in the early 1970s, the legendary Dr. Larry Weed - the “father” of the EMR - said prophetically, “The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.” — Dr. Lawrence Weed, “Your Health Care and How to Manage It.” Dr. Weed was a tremendous force in evolving health care technology to where it is today. However, his work took decades to get to a point that, unfortunately, feels like a starting line today.

Speaking of decades, it has been 10 years since President Obama introduced the Health Information Trust Alliance (HITRUST) Act of 2009, which, along with “meaningful use” incentives of Obama Care, propelled the industry toward the use of EHRs by laying the framework for widespread, secure use of modern interoperability standards such as HL7, FHIR, and Continua. This often overlooked aspect of the HITRUST Act has been a tremendous catalyst to leverage technology for better patient outcomes.

Barriers to Progress in Interoperability & Data Openness

Although ideas of interoperability and openness have circulated for many years, progress in these areas has been relatively slow and not without obstacles. In his keynote lecture at the 2016 Connected Health Symposium, Dr. Harlan Krumholz, MD, SM (Professor of Medicine and Director for Outcomes Research and Evaluation at Yale), describes one such barrier: the perceived conflict between individual business interests and the interests of the industry at large. In short, some data holders (i.e. hospital systems, payers, pharmaceuticals, software vendors) feel that it is to their competitive advantage to restrict access to the data in their possession and, in doing so, have presented major challenges to using all available resources to provide the best possible patient care.

Modern Technologies Attract Major Tech Players Supporting Data Openness

Luckily, corporate bureaucracy has not completely impeded the advancement of technologies that will enable new ways to deliver health care. The evolution of HL7 FHIR and other internet standards are laying the foundation for fast, secure open APIs and web services, key components to creating a patient-centric system in which providers can focus on what they do best - guide patients to better health outcomes. These modern technologies have drawn the attention of many big time technology players to health care (i.e. Apple, Microsoft, Salesforce, Amazon, Google), further supporting the drive for data openness.

Innovation & Cooperation in a New Era of Health Care Technology - It's Exciting!

This renewed spirit of cooperation is certainly needed as we continue to push for a health care world that is both patient-centric and provider-friendly. It is sweet music to our ears at pMD, where we have many years of experience integrating with different health systems and software vendors across the country. We’ve encountered our fair share of roadblocks along the way, but those obstacles pale in comparison to the many successes we've had in supporting doctors to improve patient care while streamlining business operations.

2019 may indeed be a milestone year due to a perfect storm of policy change, technology maturation, and the expectations of both patients and providers in regards to technology. The demand and opportunity for change at this scale is much bigger than any one company, and I'm personally very excited about what we (as a collective industry) can do for both providers and patients as we all continue to innovate and cooperate in this new era of health care technology.

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:

•  Past studies have struggled to determine whether workplace wellness programs actually improve the health of employees and if it’s worth the $8 billion industry that it’s become. A large-scale study, recently published by the University of Chicago and Harvard, has discovered that incentives and a more targeted approach to these programs may be the key to positive health outcomes.  Read More

•  Telehealth is currently being utilized by 1 in 5 physicians, a 5% increase since 2015, and is expected to skyrocket in the next few years. A new survey from American Well found a correlation between physicians’ likelihood to use Telehealth and physician burnout.  Read More

•  OrthoAtlanta, one of the largest physician-owned orthopedic and sports medicine practices in the greater Atlanta area, has started using an AI-powered, voice-enabled digital assistant named Suki. The technology leverages artificial intelligence to become a digital scribe, capable of completing notes to ease the burden of documentation by clinicians. The practice saw their average note completion time decrease significantly as well as many other advantages.  Read More

•  A hand-held ultrasound scanner, Butterfly iQ, is being utilized in rural countries that have limited access to X-ray machines, CT and MRI scanners. In some African villages, the scanner is being used to check for pneumonia and other potentially fatal conditions. The battery powered device, which can connect to a mobile phone, is expected to have huge diagnostic potential.  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. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, and care navigation software.

Here's The Latest in Health Care:

•  In a new study, research suggests that sitting for more than 13 hours a day can cause metabolic problems, even with exercise. Exercising can improve our metabolisms and keep our blood sugar and insulin levels steady. Being inactive, however, has the opposite effects, raising the risk of diabetes and heart disease.  Read More

•  Interoperability in health care should not only be thought of as a goal but also as an ongoing process that continues to evolve and be redefined with emerging technologies. One health care expert says health care should simplify its approach to data exchange by focusing on worthwhile use cases, sharing first, and then standardizing later. A more unified infrastructure should be in place in order for patients to access their entire medical record.  Read More

•  New York City is now declaring a state of emergency and calling for mandatory vaccinations after over 285 cases of measles have been reported since October. Brooklyn neighborhoods, Williamsburg and Borough Park, have been hit the hardest. All unimmunized children and adults in this area are mandated to receive vaccinations and those who do not comply could incur fines and violations.  Read More

•  Walgreens is opening a series of primary care clinics in Houston as part of its new health care delivery models and in partnership with VillageMD. The first locations are scheduled to open by the end of the year, with plans to possibly expand in Texas and other markets.  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. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, and care navigation software.

For over 10 years, I worked in the finance industry. There were many things I liked about it and I learned so much, but last year I made a drastic switch to the health care technology industry. You may ask why the big change? Why walk away from an industry that has so many financial benefits? The answer for me was family.

Recently, my family had to deal with some pretty serious health situations that made me reflect on how and where I was spending my time. Making the transition into the health care industry and to a company that is truly doing something meaningful, like improving patient care, was important to me.

For the last 3 years my dad has been on dialysis. Before he started, aside from knowing that he had to undergo a procedure that had to do with cleaning his blood, I had no idea what the world of dialysis entailed and the toll it takes on a person and their family. My dad’s situation led me to want to learn more about dialysis, the benefits of home dialysis, the latest technology, and how it can improve the lives of patients like my dad.

Through my dad’s experience, I got to see first-hand the toll it takes on a person and how it affects a family. The dialysis process is a huge time commitment. He was hooked up to a machine for 5 hours a day, at least 3 days a week. The wear on his body was pretty intense - he was wiped out after dialysis, so much so that it was hard for him to drive himself home afterward. Our biggest concern was that he could potentially fall asleep at the wheel.

All this made me wonder what, if anything, he could be doing to improve his quality of life? My research led me to home dialysis.

Before we talk about dialysis, let's talk about your kidneys and what they do

Your kidneys filter extra water and waste out of your blood to make urine, they help control chemicals and fluid in your body, help control your blood pressure, help keep your bones healthy, and help make your red blood cells.

When your kidneys don’t work the way they should, they allow waste and water to flow back into your bloodstream. Poor kidney function makes it harder for the rest of your body to work the way it should. Chronic Kidney Disease (CKD) occurs when kidneys are no longer able to clean toxins and waste from the blood and perform their functions to full capacity. This can happen over time or all of a sudden! Kidney failure, or end-stage renal disease (ESRD) is when your kidneys fail. It means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

Out of the approximately 100,000 people on the transplant waiting list, there are only enough kidneys for 20% of patients. That leaves 80% or 80,000 patients with kidney failure whose only hope for survival is dialysis.

Let’s look at some interesting and scary statistics

1) 1 in 3 American adults is at risk for kidney disease.

2) 30 million people or 15% of U.S. adults are estimated to have CKD (that’s 1 in 7 people). Most aren't even aware of it!

3) Kidney disease often has no symptoms in its early stages and can go undetected until it is very advanced.

4) According to the U.S. Renal Data System, in 2013, among fee-for-service Medicare patients, total medical costs were $50.4 billion for CKD (excluding ESRD), and another $30.9 billion for the ESRD patient population.

In my research, I learned that recently a couple of celebrities have spoken very openly about their struggles with kidney disease:

* Actor, Sarah Hyland (Haley of Modern Family), discussed in the December 2018 Issue of Self magazine both her physical and mental struggles with CKD.

* In October 2017, in an interview with Today, Selena Gomez opened up about the kidney transplant from her best friend that saved her life.

So what is dialysis?

Dialysis is a way to artificially clean the blood if your kidneys can't. It rids your body of unwanted toxins, waste products, and excess fluids by filtering.

There are two types of dialysis:

1) Hemodialysis is the most common - during hemodialysis, your blood travels through tubes from your body, through the dialysis machine, and back to your body.

2) Peritoneal Dialysis is done inside your body. The inside lining of your own belly (peritoneum) acts as a natural filter. Wastes are taken out by means of a cleansing fluid, which is washed in and out of the belly in cycles.

Where is dialysis done?

Dialysis can be done in two locations, either at a dialysis center, which is the most common, or in a home setting.

Compelling benefits to home dialysis:
- Better clinical outcomes and can be gentler on the body
- Quality of life benefits - less travel time and expenses, improved understanding, lower rates of depression, unemployment, and more overall flexibility.

There have also been some industry changes that are making it easier to do home dialysis:
- Medicare is now taking steps to make it easier. 
- New machines are now more patient friendly and smaller.
- New technology is improving communication with the machines and the doctors.
- Telehealth - Congress is allowing for remote telehealth visits with a nephrologist under Medicare, providing even more flexibility.

How does pMD fit in?

pMD not only cares deeply about doctors, but also about patients. The care of a dialysis patient takes a team and pMD’s Care Coordination tools give care coordinators, nurse navigators, social workers, and specialists a way to share information. With the release of pMD’s video chat capability, providers are now able to connect with a patient from their home.

I’m happy to say that my dad is part of the lucky 20% that has received a kidney transplant and I’m lucky to work at a place like pMD that cares so much about patients.

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.