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:

• 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.

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 for the last few years, I’ve learned first-hand how customer interactions can serve as an outside perspective that companies need.

Product Support as 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.