The pMD Blog

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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:

•  According to the American Cancer Society, less than five percent of cancer patients in the US participate in clinical studies, even though doing so could improve care and prolong their lives. There are several common barriers to pursuing clinical trial treatment, including restrictive enrollment parameters, fear of receiving placebos, and insufficient information. Clinical trial navigators who work to locate and help patients understand trial options can help increase the number of cancer patients involved in clinical trial programs and increase their odds of fighting the disease.  Read More

•  CMS is proposing updates to electronic prescribing standards that would ensure secure transmission and expedite prior authorizations by allowing clinicians to complete these transactions online. If and when these standards are finalized, all Medicare Part D plans would be required to support them. The new rule aims to reduce the amount of time it takes for physicians to complete transactions electronically and for patients to receive their medications.  Read More

•  The scientific community has long been working on treatment to counteract the effects of chronic pain. Although a solution may be a long way away, new research has revealed a protein expressed on the surface of nerve cells that could be targeted for drug treatment. Scientists have conducted successful experiments on laboratory mice that showed the potential for reducing neuropathic pain, pain triggered by chronic diseases such as diabetes and multiple sclerosis.  Read More

•  New research from the University of Pittsburgh has ophthalmologists and engineers working to develop a neuromorphic vision system to capture visual information in a new way. Instead of the conventional frame-by-frame image sensing model, this neuromorphic system is based on timings of changes in dynamics of the input signals.  This model, inspired by the human brain, should benefit new technology such as neural prosthetics and self-driving cars. The improved approach will work more efficiently and enhance computational abilities to create technology that seemed impossible years ago.  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.

Design Thinking: An Empathetic Approach to Innovation article

Design Thinking: An Empathetic Approach to Innovation

The original Apple computer mouse. A children’s toothbrush with a fat, grippy handle. pMD’s secure chat with patients. What do they have in common? They are all prime examples of products born from a thorough design thinking process.

What is Design Thinking?

At its core, design thinking can be defined as a human-centered approach to problem-solving. The process of design thinking is often simplified into five steps: empathize, define, ideate, prototype, and test.

Design Thinking Model

(source: Stanford

In my discussion, I’ll take a deeper dive into the first two steps (and arguably most important): empathizing with the human and defining the problem.

Empathy and Definition in Design Thinking

What do empathy and problem definition look like in practice?

In 1966, designers were approached to reimagine a children's toothbrush. At the time, all children’s toothbrushes were fairly similar: shorter versions of adult brushes, which were skinny sticks with a brush head. The designers spent a large amount of time simply watching children and adults brush their teeth. What they discovered was revolutionary -- children, unlike adults, gripped the brush with a clenched fist. In contrast, adults displayed increased dexterity and balanced the brush between their fingers. To tackle this difference, the design team created a new toothbrush featuring a thicker handle lined with squishy gel. An adult might not care for the design, but to a child, the thick handle and colorful, grippy gel made all the difference. That model quickly became the best-selling toothbrush worldwide...for the next 18 months. Needless to say, the rest of the market caught on, and now all children’s toothbrushes still feature the same original design elements: a fat handle with grippy gel.

The reason for the success of the children’s toothbrush is that the design team first empathized with the human (“Why is brushing my teeth no fun?!”) before defining the problem they were actually solving (“Why is my toothbrush difficult to use and hold?”). Connecting with the customer is arguably the most important part of design thinking, because without the human connection, designs often miss the mark for real-life use cases.

Design Thinking at pMD: Empathy is #1

Empathy forms the basis of all pMD interactions with customers. In meetings and on support calls, before diving right into what might be wrong or how customers might need our help, we first make sure to check in and ask how their day is going or what exciting plans they have made for the weekend. Talking with customers about their daily life not only shows that we see them as real people with real lives, but these seemingly trivial conversations can also yield intriguing insights into how we can improve our products. For example, when talking with some of our users, we found their day was less than ideal due to an increased amount of time spent playing phone tag with patients. This led to an internal discussion about improving provider communication with patients and ultimately resulted in a new Chat with Patients feature available soon for all users of pMD. Through constant refinement and testing, we eventually created a solution that both providers and patients love. This positive response stems from a deeply-rooted passion for the most important steps of design thinking: empathizing with people and hearing their real problems. At pMD, we wear many hats, but the one that we wear first and most proudly is the hat of empathy. When empathy and design connect, wonderful solutions abound:

Customer Reviews of pMD Chat with Patients

I urge you to challenge convention and speak to your customers on a more personal level. Instead of viewing customers as numbers on a spreadsheet, see them as people that you can help in ways you haven’t yet discovered.

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:

•  The Cleveland Clinic partnered with Propellar health to find that the use of electronic inhaler monitoring reduced hospital visits for COPD patients by a significant average of 1.2 trips per year. A small sensor was combined with patients’ existing inhaled COPD medication, sending alerts on medication adherence and usage to the patient’s smartphone. The digital medicine data gathered from the study allowed clinicians to receive information on patients’ adherence to their medication regimen, information they were previously unable to objectively monitor.  Read More

•  In an effort to impact public health, Facebook is expanding a feature that helps coordinate blood donations by allowing blood banks and other health care facilities to alert users where there are shortages. The tool will launch in major cities such as San Francisco, Chicago, New York City, Washington D.C., and Baltimore. According to Facebook’s Product Director of Health, one donation of blood can potentially save three lives. Facebook’s goal is to help raise awareness around this problem and make it easier for people to donate blood.  Read More

•  Research shows that spending time outdoors can reduce stress levels, decrease blood pressure, boost mental health, and increase life expectancy. According to the journal Scientific Reports, the recommended amount of time one should spend outside per week is about 120 minutes. People who spent less than 2 hours outside per week exhibited a lesser sense of well-being and did not reap as many health benefits as people who did. This new development has led clinicians to start prescribing nature for their patients, acting as a treatment for stress.  Read More

•  According to a new report by the American Cancer Society, the number of cancer survivors in the U.S. is steadily increasing. Researchers claim that these improvements are most likely due to better screening and treatments. Although survivorship has increased, there are still barriers that cancer patients face after completing treatment. The report found that differences in race, health insurance coverage, and wealth impact challenges patients may have in surviving cancer.  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:

•  An upcoming HIMSS session in Finland will examine the cross-sector collaboration between the pharmaceutical and technology industries and how such a partnership could add tremendous value to improved patient outcomes and experiences. The pharmaceutical industry offers deep knowledge about patient data in addition to scientific expertise, while tech provides ways to capture data and make predictive analytics. However, the differences between the two industries could present a significant barrier to seeing this collaboration work well on a large scale.  Read More

•  According to a new study, two-thirds of health systems in the U.S. are very slow at scaling innovation, and many still do not have a clear definition for the term. A health system’s approach to innovation usually corresponds to its system-level priorities, such as reducing cost or improving patient outcomes. It was also found that less than half of health systems had a formal process or department dedicated to innovation, and some turn to outside organizations such as tech companies to help develop strategies.  Read More

•  A new study from the Monterey Bay Aquarium Research Institute found that microplastics have made their way into the deep ocean. After taking samples from up to 3,000 feet deep in the Bay, researchers found that microplastics were widely distributed throughout the surface and deep-water levels, meaning that these microplastics are not just washing off the California Coast, but also coming from other parts of the ocean. The study also found that out of 2,000 fish examined, one in every three has plastic in its stomach. This means that plastic being introduced by humans is also being introduced into the marine food web, ultimately affecting animals that people consume.  Read More

•  Research conducted at the University of Bergen shows that gum disease plays a role in developing Alzheimer’s disease. Results from their study prove that bacteria causing gingivitis can move from the mouth to the brain, producing a protein that destroys nerves cells leading to memory loss. To lower the risk of Alzheimer’s, professionals encourage brushing and flossing your teeth to reduce the presence of these bacteria. Researchers have also developed a new medicine for blocking the harmful enzymes these bacteria excrete, slowing down the progression of Alzheimer’s.  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.

Health Care Communication: Electronic vs Paper Follow-Up for Millennials article

Follow-Up for Millennials: Paper vs. Electronic Health Care Communication

I am 23 years old and, unfortunately, I have already had my fair share of injuries and medical mishaps. These injuries have led to plenty of urgent care and emergency room visits, several rounds of physical therapy, and even a couple of surgeries. Each of these encounters has been accompanied by some varying amount of post-visit instruction from my health care providers, most commonly in the form of a paper packet. For physical therapy there were exercises, for kidney stones there were instructions on prevention, and with surgery came a list of symptoms to look out for after the operation.

Problems with Paper Patient Education Packets

The paper packets worked fairly well in a couple of regards: I always trusted the information I was getting, I could reference what the physician told me if I had forgotten, and I often had access to helpful diagrams alongside the instruction text. I was, however, very prone to losing or destroying the important yet vulnerable packet and the information it contained. All it took was one spilled cup of coffee, a visit from the overzealous family dog, or a well-meaning mass recycling effort, and I was back to using the internet to guide me or calling up my doctor’s office for information.

These paper packets came with a couple of other flaws. In addition to the extra paper resources used (save the trees!), they didn’t cover every single question that I hadn’t known to ask when I was sitting with the physician. Also, in the event I wanted to share the information with a friend or family member, I would have to find a scanner, to which I normally did not have access. I would usually settle for a photo from my phone sent over text messaging, which was a cumbersome process with a low-quality output. In the end, these packets served a limited purpose for a short amount of time.

Electronic Health Care Communication is Easier for Millennials

What form of communication would have been easier for an injury-prone twenty-something? In my opinion, the top priority is to deliver the information electronically, preferably on a smartphone. That way, I wouldn't lose the information provided by the medical practice and could easily share that information with others. Ideally, I would also have the ability to reach out to the physician in the event of a complication or additional follow up questions.

Of course, it is important that any health care communication tool does not become a hindrance to the physician or inhibit their ability to complete their daily tasks. In the end, I was looking for a mobile application that I could use to reference and share files that also gave me the ability to contact my physician.

Benefits of Communicating Electronically with Patients

The electronic delivery of information has more benefits than simply preventing someone’s dog from eating their post-surgery instruction packet. It also allows patients to access information more relevant to their needs, as well as make information more accessible and more portable. Patients can also have direct access to a knowledgeable health care professional, rather than turning to the dubious activity of searching their symptoms on the internet.

At pMD, we are dedicated to helping overcome communication barriers wherever they exist in health care. We are similarly dedicated to building software, including HIPAA-compliant text messaging with patients, that is up to the usability standards of modern websites and mobile applications. This dedication to quality ensures that everyone is able to use pMD’s software with ease, regardless of their comfort level with technology.  All in all, our goal is to provide more effective communication between patients and health care providers, ultimately resulting in better health outcomes for 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.

Here's The Latest in Health Care:

• KLAS, a leading health care research firm, published a new report that found that hospitals benefit from the Prescription Drug Monitoring Program data included in their EHR systems. Prescription intelligence software arms health systems across the nation with information to stop over-prescription and identify patients who should not be prescribed opioids. For the report, KLAS surveyed providers and found that the top-ranking prescription intelligence vendors have EHR integration, clinical decision support, and are cost-effective. Read More

• According to a new study, the expansion of Medicaid has increased the number of women insured, leading to a decrease in maternal deaths and infant mortality. States that expanded Medicaid have had a 50% greater reduction in infant mortality rates than states that have not. Medicaid expansion has helped women maintain continuous health coverage before, during, and after pregnancy, leading to healthier mothers and babies. Read More

• H.I.V. researchers and scientists face a major obstacle in the lack of female participants in clinical trials. There are 35 million people in the world with H.I.V., and women make up over half of this population. Men and women are impacted significantly differently by diseases, including H.I.V, which makes it important to have both sexes equally represented to find a universal cure. Read More

• According to a new study, skipping breakfast before exercising can affect our relationship with food and reduce the amount we eat for the rest of the day. In a small study, scientists from the University of Bath in England found that working out on an empty stomach depleted most of the body’s stored carbohydrates, and the subjects consumed more calories around lunchtime. However, unlike the scenarios where subjects did consume breakfast, their food consumption trailed off towards the end of the day and the participants burned more calories than consumed overall. 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:

•  The World Health Organization has announced a new Health Product Profile Directory, a free database of health products that are currently in development to treat infectious diseases and other global health threats. According to a WHO report from February, billions of dollars are spent on the research and development to improve health products, but the funding does not always go to the areas affecting global public health the most. The Health Product Directory, which currently has 196 product profiles and growing, was created to assist in guiding the global health research agenda and improve overall public health.  Read More

•  A recent study found that eating ultra-processed foods such as canned food, frozen dishes, and packaged snacks can be associated with weight gain. The research team conducted an experiment to test the outcomes of an ultra-processed diet versus the consumption of whole or unprocessed foods. Subjects on an ultra-processed diet averaged 500 calories more per day compared to when they were eating whole foods, and as a result, gained weight. It was also observed that when eating processed food, people tend to eat more quickly and consume more, leading to decreased levels of an appetite suppressant hormone called PYY. Obesity, a condition affecting about 40% of American adults, is a contributing factor in the development of heart disease, diabetes, stroke, kidney disease, and cancer.  Read More

•  Policymakers in Washington are currently devising a solution for the unexpected and pricey medical bills patients receive after care from a doctor or health system outside of their insurance network. Patients often are forced to see providers outside of their insurance network when they don’t have access to in-network providers or services. The Senate’s proposed legislation would protect patients treated by out-of-network providers, meaning the patient would not be accountable for paying more than what their insurance covers. The House presented a similar “No Surprise Act,” which does not include the “median in-network rate” clause that pays providers a predetermined rate based on what other health plans are paying for similar services. Congress is currently still negotiating the proposed bills.  Read More

•  According to a new analysis of private health insurance claims, behavioral health cases have increased from 1.3% to 2.7% of all medical claims in the past decade. The majority of the increase came from patients 22 years old and younger, most commonly diagnosed with major depressive disorder and generalized anxiety disorder. Emergency department visits for this patient population have also increased. Health systems are doing their best to adapt to the growing need for behavioral health services; these efforts include increasing available services and educating both children and parents about the options available to them.  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.

Benchmarking Length of Stay article

Benchmarking & Reducing Length of Stay in Hospitals

pMD prides itself on helping providers and practices accomplish their goals and measure their quality improvement initiatives. In the inpatient environment, we often work with groups that are interested in tracking patients’ length of stay (LOS) and assessing how their data compares to estimated values for particular medical conditions or patient populations.

While there are many views on which calculation is the most accurate for a patient’s estimated length of stay, for the sake of this discussion, I will use the geometric mean length of stay (GMLOS) as the value associated with the estimated LOS.

What is GMLOS?

The GMLOS is based off of the patient’s diagnosis-related group (DRG), which is a system of grouping together clinically similar patients. Several different classification systems exist with varying levels of grouping precision and levels of specificity. For example, CMS utilizes MS-DRGs (Medicare Severity Diagnosis Related Groups) to assign a specific GMLOS to each DRG in their system.

Why is Length of Stay Important?

When clinically viable, reducing hospital length of stay has been proven to provide both positive results for patients and financial benefits for the institution. In many cases, hospitals do not receive additional reimbursement once a patient’s stay has passed the GMLOS for their assigned DRG.

The DRG, calculated from the patient’s diagnosis, relies on accurate and thorough coding. One study estimated that 40.6% of patients in a specific facility could have benefitted from having a more accurate DRG assigned. Allina Health, a not-for-profit health care system based in Minnesota, has realized a financial gain of 13 million dollars by implementing a length of stay optimization effort across their system.

Methods for Reducing Length of Stay Compared to Benchmarks

Several strategies, such as provider education on statistics and benchmarks, earlier discharge order entry, and increased case management and care coordination efforts, have proven successful for increasing the percentage of patients meeting - or beating - the GMLOS for their condition. However, providing real-time data to care providers stands out as one of the strongest ways to optimize for length of stay. If the care team and administration members do not have a way to access the comparative statistics while the patient is still in the facility, they cannot address this data during their clinical decision-making process, making it impossible to effectively target interventions.

Benchmarking LOS is most useful when the information is supplied in an on-demand manner, allowing educated care teams to use the relevant information when needed. Implementing a system that provides this feedback in real-time can be difficult and involves concurrent coding teams working together with clinical care teams.

Once the data is readily available, health systems can then act to improve it, taking on projects such as selecting specific DRGs to target for improvement and starting conversations between providers and coders when benchmarks don’t seem clinically accurate. In the end, the patient benefits from a more collaborative care planning initiative that takes full advantage of all available information and includes options for care outside of the inpatient environment.

pMD’s Charge Capture, Clinical Communication, and Care Navigation tools all offer the capability to give relevant information to caregivers at the right time, while avoiding cognitive overload. We’ve worked with enterprises to introduce functionality to support their quality initiatives with real-time data. If you’d like to discuss your organization’s current initiatives and goals around length of stay, reach out to us! We’re all ears.

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:

•  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.