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:


•  In Q2 of 2018, there were 142 health care data breaches with over 3 million patient records compromised. The worst part about it? About a third of those breaches were caused by repeat offenders within the organizations. What does this tell us? It tells us that by not providing the proper training and reporting, an organization puts themselves at high risk of continued breaches. So how about that training manual?  Read More

•  How accurate are diagnostic health apps? As technology evolves in the health care space, more and more people are turning to websites and diagnostic health apps for answers to their health questions. The disadvantage to these frequently-accessed platforms? They're severely understudied and not as regulated as we'd expect.  Read More

•  Families of drug users have long been advised to practice tough love as a means of getting their loved ones through rehab. However, recent studies have shown that being empathetic while encouraging a voluntary treatment approach is an effective way of engaging drug users in their own recovery and keeping them alive.  Read More

•  Cockroaches, and ticks, and boxers. Oh my! How caught up are you with this week's health care news? Take this weekly health quiz to find out.  Take the Quiz

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, clinically integrated network, and care navigation software.





In the health care landscape these days, security and data protection concerns are as common as thermometers and stethoscopes. As a health care technology company, data protection can’t just be on our “to do” list. It has to be in our company DNA. If it wasn’t, we’d never close a deal, and our potential clients - medical practices of all sizes - would run screaming in the opposite direction. And, we wouldn’t blame them!

At pMD, security has always been at the core of what we do. In fact, our original infrastructure was prefaced on the highest security standards established at the time - those of the financial industry. In our daily work lives, we understand the privilege of handling a person’s Protected Health Information (PHI) and demand a high level of respect and care from every team member. I often find myself hypothesizing, “What if this were my mother’s health information? How would I want it to be handled?” So, when a large potential customer asked us to perform an annual third party audit by an AICPA accredited firm, I gave an enthusiastic “yes!” To be completely honest, I had no idea what an audit really entailed. But, I knew doing so meant an unbiased third party would come in and gut check each of our decisions, while considering our specific business, goals, and culture. Yes, please!

So, here we are, almost two years after that initial audit request, with our first audit successfully completed, and our second one not far in the distance. What did we learn? Well, in a word ... lots. But here are a few big takeaways.

Audit standards vary.

Not all audits are the same, and the differences are largely driven by the standards used by the auditors. One of the most common groups of standards is the SOC standards. A SOC report provides an analysis of a service organization’s internal controls so that users can better understand the risks associated with sharing sensitive information with this external organization. There are three SOC reports - SOC 1, SOC 2 and SOC 3. Each one makes sense for different industries and company types. Then, within the reports themselves, there are different criteria. For example, within a SOC 2 report, there are criteria related to security, availability, processing integrity, confidentiality and privacy. At pMD, security was our top priority, and a SOC 2 audit made the most sense. So, we started with a SOC 2 covering the Security Trust Services Criteria, and will consider folding in new subject areas as we move forward.

There are also two different types of SOC reports, Type 1 and Type 2. That means a company could complete a Type 1 or Type 2 SOC 1, SOC 2, or SOC 3 audit. A Type 1 report assesses controls as of a point in time, whereas a Type 2 report assesses controls over a period of time, usually six to twelve months. For our first audit, we decided to complete a Type 1 and will build that effort into a Type 2 for our second audit.

In planning our audit, we also knew how important HIPAA compliance is to each and every one of our users. So, we also completed a HIPAA audit, where our auditor used the HIPAA requirements to assess whether our security controls are adequate to meet our HIPAA obligations. Knowing that security and HIPAA would be of the utmost importance to our customers, we prioritized both those sets of standards and hope to expand them in the future.

Be open, be honest, be organized.

In the months leading up to our audit, our team had quite a bit of jitters. It felt like someone was coming into our home, looking for dirt as they wiped their finger along each of our shelves. We knew we wanted the auditors to have a full view of what we were doing, but we were still nervous that our processes weren’t “good enough.” We handled these nerves by ensuring that we were as prepared as possible before our auditors arrived onsite, sending them all requested information well before they arrived to our office. We also made the conscious decision that this audit would only be helpful if we were up front and open about what our security processes really are. So, we were open and honest with our auditors, which brings me to our next point…

Let your auditors be collaborators.

Of course, an auditor inherently has to be objective and can’t advise a company on how to meet it’s security standards. But, at the same time, auditors have a wealth of experience and knowledge, and have seen hundreds of companies’ security configurations. So, if you’re working with a good audit firm, they’ll point out areas in which you could improve, and then offer various ways they’ve seen this security control addressed, including industry best practice. Auditors can offer invaluable insights, and this perspective really helped pMD maximize the value we received from completing our audit.

There’s no silver bullet.

Of course, completing an audit doesn’t mean that a company will never have a security problem - though I certainly wish it did! But, what it does mean, is that you can sleep better at night knowing that an objective third person finds your security systems reasonable. And, from a customer standpoint, it means you don’t have to simply trust us when we tell you that we prioritize your data’s security. The proof is in the pudding - the audit reports not only clearly outline our security protocols but, more importantly, the audit indicates a culture of security awareness. It’s proof that pMD is willing to invest a great deal of time and money to ensure that our security protocols are up to par. And that means that when you engage with pMD - a responsibility we don’t take lightly - you can sleep better at night, too.

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




Here's The Latest in Health Care:


•  Squirting generous globs of that alcohol-based hand sanitizer? A recent study found that some bacteria are becoming tolerant of hand sanitizers that are used in hospitals. Scary! While these type of disinfectants help with battling staph infections in patients, rates of other infections didn't drop when sanitizing stations were used. In some cases, infections actually went up.  Read More

•  In an effort to combat the ongoing opioid epidemic, the NIC announced on Wednesday that the RxGov platform will be applying machine learning to prescription drug monitoring programs. The cloud-based platform will help track opioid prescriptions, integrates with EHRs, and includes data transparency.  Read More

•  AmeriCorps' latest service line, MedServe, allows pre-med students to work in health care clinics in underserved areas. Students gain more meaningful early-career experience while providing assistance in clinics in rural communities that are often short-staffed.  Read More

•  As doctors move away from prescribing opioids for pain, patients with chronic back pain are turning to a risky treatment - an injectable drug that, if used along the spine, can be dangerous. Depo-Medrol is an anti-inflammatory meant to be injected into muscles and joints but doctors who prescribe it have long been giving these shots close to the spine.  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, clinically integrated network, and care navigation software.





According to Becker’s Hospital Review, several experts from UCSF’s Center for Digital Health Innovation have outlined their vision for a Connected Health Record. Aaron Neinstein, MD, Mark Savage, and Ed Martin proposed that “we need a connected health record” and defined it as follows: “the connected health record achieves true completeness by focusing on the dynamic conversation, teamwork, interconnections, and diverse data sources inherent in managing health and healthcare today.”

As a concrete example, they discussed the shared plan of care that “all care team members can update [...] electronically in real time with inputs and outputs to and from a multitude of systems.” Communication is also a critical aspect of the Connected Health Record. “Recommendations and changes in care plan from any one of those providers will be communicated to and accessible automatically for the entire care team.”

This all sounds great! But where should it live? Not, the authors rightly argue, within the existing electronic filing cabinets: “the construct of electronic health record as electronic filing cabinet remains deficient” and “a chorus of physicians and patients is crying out that EHR systems are already cumbersome and inefficient. Imagine how much worse this might become if EHR systems grow and grow to accommodate new use cases.”

Perhaps it should be some other piece of software that connects to the filing cabinets via APIs. That would allow you to view all of your information that is in different EHRs, without needing to copy it all into a single institutional health record. In fact, this software already exists today. It is an app called Health Records, and it was created by Apple.

Of course, the patient controls this app, not any institution. But isn’t that how it should be? Isn’t that necessary to achieve the goal of a connected health record that stands apart from all the institutional records and the various electronic filing cabinets? Why should an institution be able to view another institution’s data? This violates basic business principles - the incentives are aligned against it. Only the patient and their health care proxies should control the complete, connected record of their health.

So far so good, but what about the shared plan of care and the communication between the patient, their family members, care navigator, and all of their health care providers at different institutions? We’re still missing a critical piece of the Connected Health Record.

But wait, are those things actually a health record at all? A shared plan of care that lives with the patient and is visible to everyone in that patient’s care team… the ability for any providers from different institutions to communicate with each other, as well as with the patient… that’s not a health record at all. It’s a Clinical Communication app! And this, too, already exists today.

Connect the health records and create a single view of all the data that the patient controls. Then, empower the patient to selectively share that information with anyone on their care team. Finally, give all those health care providers a living, shared plan of care that they can update in real time. Now that is connected health care!

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




Here's The Latest in Health Care:


•  Medicare covering the cost of air conditioning units? Sounds like a stretch but starting next year, these window units could be considered a "supplemental benefit" under Medicare Advantage plans for patients with asthma. For a third of those insured by Medicare under Medicare Advantage plans, they can look forward to some changes being made next year. Among the new benefits: eyeglasses, hearing aids, gym memberships, and adult day care programs.  Read More

•  When you get a warning from the U.S. Department of Homeland Security, you know it's serious. Health care organizations are being warned of nation-state hackers and other cybercriminals who are targeting web-based applications designed to help organizations manage finances, HR issues, and other business activities. These systems are a treasure trove of personal data. How to thwart future attacks? Better patch management!  Read More

•  When you think about a rocket launcher, the last thing you'd associate it with is a concussion. But many Marines who fired powerful, shoulder-launched weapons during training have reported experiencing the symptoms of a concussion, like short-term memory problems, nausea, fatigue, and dizziness. The long-term effects directly correlated to firing rocket launchers are still up for debate but for many Marines, signs of brain damage are very evident.  Read More

•  Google is teaming up with the National Institutes of Health (NIH) to create a biomedical database, aiming to give researchers more accessible, high-value biomedical data sets. Funding for this project is expected to reach $16 million, however NIH declined to confirm specific financials surrounding their partnership with Google.  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, clinically integrated network, and care navigation software.





When I was an intern in college, I remember thinking, "wow, these free snacks are such a treat." Little did I know that I was missing out on so much more from a work environment. Nowadays, the bar is set so high that it’s barely a blimp in the sky. With startups offering impressive amenities like game rooms, unlimited paid time off, trips abroad, catered meals, shuttle buses, and even onsite gyms, how does a candidate even begin to know which place is the best place for them?

Take it from someone who works for a company that has actually been awarded a Best Place to Work (BPTW) many times over -  it’s all smoke and mirrors unless you can find the right balance of work, culture, and life. So what does it take to win and sustain multiple BPTW awards? While there’s no simple formula, and every company’s situation is varied, I’d like to think of these as the key building blocks that form the foundation of a desirable office environment:

Take Your Time, Be Extra Picky

I’m sure you’ve heard about the extensive hiring processes at some of the major tech companies, like Google's 9+ step process, for example. It’s insane to think that a hiring process can span several months but there’s a good reason for it. At pMD, we may not reach the level of a 9-step process but ours is certainly as thorough and comprehensive. We choose to do it this way not with the intent to intimidate but to find that special candidate who can ultimately accept any challenge, think analytically, engage with customers on a meaningful level, and interact seamlessly with the team. In short, we’re extra picky about who we recruit because we want the absolute best and brightest who’s passionate about improving health care and becoming an integral part of our pMD family. We also appreciate a good dad joke here and there. Got any?

Reward Your Team, They Work Hard!

According to a recent article by Training Journal, “staff are any organization’s most valuable asset and [...] need to be nurtured, supported and encouraged if they are to be successful”. I couldn’t agree more. pMD does a great job of rewarding not only individual performances but also performance across the entire team. With our quarterly and annual assessments, we can look forward to rewards like cash incentives, cabin leases in Lake Tahoe, a day at the spa, a day spent racing cars on a track, a new coffee machine for the office, dinners at upscale restaurants, credits to purchase your favorite bottles of wine or spirits, and even trips to tropical destinations. Your team should know they’re valued, so showing your appreciation by way of incentive, big or small, is always a show of good faith.

Focus on Career Development and Transparency

I think one of the biggest mistakes a company can make is to neglect the professional development of its employees or better yet, to not make that its biggest priority. Building a successful company and successful team starts with nurturing at the individual level. However, as the Atlantic points out, simply having a mentorship program in place is not grounds for successful career development. Providing transparency from all directions - from management, from mentor, and from mentee - can help a mentorship program thrive. What does that mean exactly? It means having clear expectations of the responsibilities of both the mentor and mentee and providing an open feedback channel between the company, mentor, and mentee. pMD’s mentorship program begins on your first day in the office and continues throughout your entire career at pMD. At any given moment, you can be both a mentee and mentor and that’s where I think pMD gets it right. You’re continuously learning while at the same time passing down the knowledge you’ve learned.

Let Them Eat Cake

Literally. Remember that your employees have to eat too. In between meetings. During that time of day called lunch. And one of the best things you can do to nourish your team while they work towards company goals is to provide them with catered meals, healthy snacks, beverage options, and treats for special occasions. Not having to decide what to bring for lunch or venture out for 30 minutes to stand in a long line for a $15 salad makes my time (and wallet) that much more efficient. One of my favorite pMD food perks: birthday treats. We celebrate every single  team member’s birthday with a treat hand-selected by the birthday person and shared with the entire team. It’s getting harder and harder to come up with unique ideas after options like s’mores, pies, milkshakes, root beer floats, churros, ice cream sandwiches, cronuts, cupcakes, and your classic birthday cake have already been taken!

Stress the Importance of Wellness and Family

Namaste. Wellness means more than just providing a place to meditate. The term wellness can encompass everything that leads to a balanced life. There's financial wellness - providing your employees with a robust retirement plan and annual bonuses. Physical wellness - employees receive exceptional health benefits and a private meditation, lactation, or yoga room. And even mental wellness - providing your team with the assurance that taking time off work to take care of family or personal matters is not frowned upon. All of these are essential in creating a stress-free, balanced work-life environment. Our team is like our family and their family is like our own. And there’s nothing more we'd want than to ensure our family is well and happy.

Finding that balance and knowing that you're part of a team who can all sit together at lunch, build strong bonds while traveling alongside one another on business trips, create an extensive bank of inside jokes, celebrate each other's differences and similarities, sing karaoke together until 1 in the morning, and just overall have the best time, is what makes any company the best place to work.


Want to join our Best Place to Work family here at pMD? Contact us at careers@pmd.com!

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




Here's The Latest in Health Care:


•  You might want to think twice before ordering that fifth beer at the bar. A new study found that death rates from alcoholic cirrhosis and liver cancer have soared among people in their mid-20s and mid-30s.  If you're unfamiliar, alcohol consumption is one of the many causes of Cirrhosis, which is the irreversible scarring of the liver that can lead to its cancer or failure, and ultimately can be fatal. So, what was that about another round?  Read More

•  Patient safety is important. Super important. One would think that with all this new technology, health care systems should be able to address patient safety. Well, in order to improve it, hospitals need to optimize their Electronic Health Records by strategically pacing the rollout of new features and functionalities. Basically, be realistic about rolling out new functionalities because if user experience suffers, so do the patients. Doesn't take much!  Read More

•  Ever felt like decisions were being made for you? That's exactly how many Medicaid patients should be feeling or at least aware of when being prescribed drugs by their doctors. That's because drug options under Medicaid are heavily influenced by drugmakers, even to the point where drugmakers use payments and perks to get doctors to prescribe its drugs, among other tactics. So what'll it be? The blue pill or the red pill?  Read More

•  Lower health care costs? Sounds like an oxymoron, right? Policymakers are pushing the agenda of value-based care payment models, which they believe are the key to lowering costs in health care. These models center on patient outcomes and incentivize providers for the quality of care they provide as opposed to the traditional fee-for-service payment models.  Happy patients. Happy providers. Lower costs.  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, clinically integrated network, and care navigation software.





I greatly appreciated Dr. Daniela Lamas’ perspective in her New York Times article, You’ve Detailed Your Last Wishes, but Doctors May Not See Them. Much ink has already been spilled about the failures of the electronic health record to solve the biggest problems facing patients and health care providers today. This article described a particularly tragic failure: a small piece of absolutely critical information was present in the patient’s record, but it was buried in an ocean of text. Nobody saw it during the chaos of an Emergency Department (ED) admission.

Since then, Dr. Lamas has heard about many other “situations in which last minute ‘saves’ through extreme diligence or chance, such as the one I experienced, had led to a good outcome.” This problem is indeed widespread. A 2016 study in the Journal of Patient Safety estimated that medical errors caused between 210,000 to 440,000 deaths per year in the United States, and that total Preventable Adverse Events due to medical errors occur between 2 to 4 million times per year. It’s a staggering number, accounting for up to one sixth of all deaths in our country last year!

In her article, Dr. Lamas proposed some ideas for fixing this buried information issue. The ideas included:

1. “standards for sharing [...] across all electronic records”
2. “all health systems could require identification of a health care proxy for all patients”
3. “patients should be able to access their health records through a patient-facing interface, send in their own directives, or even update related notes”
4. “all related advance care planning documentation should be in one place in the medical record and accessible with one simple click of the mouse”

Interestingly, three of these wouldn’t help with a situation like this where the information was already present in the record, yet buried out of sight. And the fourth - putting advance care planning documentation in a single place - had already been done at Dr. Lamas’ hospital. The physicians just didn’t use that screen because “habits are hard to break, and without a clear set of incentives, training, and ongoing education, doctors (myself included) continue to record information about end-of-life conversations in progress notes, where they are not readily available”. When the EHR documentation burden is already so heinously high, it’s easy to see how caregivers wouldn’t rush to embrace yet another screen added into the mix. After all, it’s not reasonable to expect the Electronic Health Record to transcend or change its nature, which is, in Dr. Lamas’ words, “a clunky online version of a paper chart”.

She did reference another approach to solve this problem, “clever patient apps that work outside the electronic record”. For an app to help in such a situation, it must not live only with a single person. The patient may be unconscious or may not have their phone with them when they’re admitted. Their health care proxy may not be reachable right away, or perhaps the patient didn’t designate one. So to make absolutely sure that any health care provider who sees the patient can access this information, the app must live with everyone possible who is involved with the patient’s care. The patient, their family members, their health care proxy, each of their physicians, and perhaps most critically of all, their care navigator.

Many of the very sick patients such as the one in Dr. Lamas’ story already have a care navigator assigned to help them navigate through our fragmented health care system and to quarterback the communication among different care teams at different institutions. This person is like the patient’s health care guardian angel. In most cases, they know the patient better than any one physician.

As long as the care navigator finds out immediately when the patient hits the ED and which doctor is seeing them, they can spring into action and make sure the really important information gets to the right person in a timely way. With pMD® Care Navigation™, care navigators can find out instantaneously when the patient is admitted to the ED and have easy access to a concise summary of the truly critical information about the patient’s care plan and decisions.

If care navigators have critical information at their fingertips, are empowered to intervene with exceptional communication software, and find out automatically when patients have their moment of crisis, then we can let the Electronic Health Record go back to doing what it was always designed to do: being the digital filing cabinet. It’s time to move forward to the next generation of software for patients, families, physicians, and especially care navigators.

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



Image: Thn Rocn Khosit Rath Phachr Sukh /EyeEm via Getty Images

Here's The Latest in Health Care:


•  After a video showing a sea turtle with a straw stuck up its nose went viral, the move to ban plastic straws has swept the nation. While trendy campaigns like #StopSucking have gained considerable traction in an effort to rid the ocean of straws, not everyone is on board. For many people with disabilities, being without plastic straws can be a matter of life or death. Alternatives such as paper or reusable metal straws often pose safety risks to those with disabilities.  Read More

•  According to a new report, health care startups benefited from $10.6 billion in venture capital investments in the first half of 2018. If this pace continues, health care investment will reach a record high this year. The health care sector has already made its way into second place among industries attracting VC investments.  Read More

•  The Justice Department's efforts to combat the epidemic of opioid abuse is expanding to drugmakers. A proposal from the Drug Enforcement Agency may require drugmakers to cut back on the amount of drugs produced in a given year if their opioids are being misused. The hope is to reduce the availability of potentially addictive drugs and for manufacturers to become more aware about how their drug is being used.  Read More

•  Some studies have suggested that spending time in lush forests might reduce stress and blood pressure, improve heart-rate variability, and lower cortisol levels. It has also been shown to improve one's mood. So, next time you're feeling stressed, indulge in a forest bath and take in the smells, sights, and sounds to boost your mood!  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, clinically integrated network, and care navigation software.





Summer is here. While everyone is making vacation plans, I find myself reflecting on my time and history with pMD and how I’ve had such great opportunities to travel, find myself, and grow alongside this company.

When I first started working at pMD, I was an intern finishing up my studies. I’d chosen to intern at pMD because I could tell they were interested in helping me grow into an integral part of the company as opposed to just a summer pastime. My internship was engaging, challenging, and really pushed me to discover many of my strengths and what I had to offer. I was given the opportunity to work on some of the most important projects central to the success of pMD. This materialized into a full-time position and I made such close friendships and relationships with my colleagues which are now akin to family.

When it was time, I had moved on to work at other organizations in different industries and environments. I wore many hats and explored different roles. While these were very rewarding and amazing experiences, I missed the sense of family and personal investment I felt with the organization who first took a chance on me.

I was at a point where I wanted to try something different - living in another country. I was ready to pack my bags and head out with no employment or source of income. I’d stayed connected with my pMD colleagues throughout the years and was able to connect with them before leaving. They were interested in hearing about my story and where I’d planned to take my journey next. More than that, they thought of ways pMD could once again be a part of my journey. I was given another amazing opportunity with this organization, to work alongside pMD remotely from Israel.

Normally, this would be a radical and unrealistic proposition, but given our history and the levels of trust established from working so closely together over the years – we knew we could make it work. As expected, they found a role for me that fit perfectly given my strengths and circumstance. I can say I’ve once again grown a ton in a short period of time, both as a person and an integral part of this company.

This is a testament to working for a truly people-centric organization. I urge anyone starting their career to work with a company invested in you personally. I’ve been fortunate enough to learn and grow here at different points in my life, and I now have the opportunity to mentor the next generation at pMD and hopefully pay it forward.

As we plan our adventures for the season, it’s important to remember our careers can work synergistically with our journeys. Enjoy your summer!

Want to join our team? Learn more from our careers page or contact us at careers@pmd.com.

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