The pMD Blog

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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.


Interoperability of health data



With the creation of MyHealthEData, and through current rulemaking, the Centers for Medicare and Medicaid Services (CMS) is pushing significant new data-sharing requirements into the market.  The new rule opens all types of doors in its effort to improve data transparency and data velocity throughout the system.

The core tenets are:

Ensuring patients have access to all health data where CMS has programmatic authority:

Any payors involved in the following programs are required to have open APIs (Application Program Interfaces): MA organizations, Medicaid programs (both FFS and managed care), CHIP (including FFS and managed care), and QHP issuers in FFEs.

These open APIs will allow patients to empower a vendor to access their claims, encounter data, utilization history, and any clinical health information (such as lab results when available) the payor may have. Payors are also to make their plan directory available through these APIs and have to share care coordination data with each other.

Electronic patient event notifications:  

As a condition of participating with Medicare and provided their EHR has the ability to produce and send an Admit/Discharge/Transfer (ADT) message, it is being proposed that hospitals should send notifications to those practitioners or providers that have an established relationship with the patient relevant to his or her care. (The requirement is waived if the receiving provider can’t receive such messages.)

Prevent information blocking:  

Providers who are not making patients’ clinical data readily available will, essentially, be publicly shamed into compliance as CMS aims to share provider attestations that the provider complies (or doesn’t) with interoperability requirements laid out in updated MIPS rules.  In my opinion, this is a seemingly weak penalty for non-compliance so hopefully, CMS tightens this to improve accountability.

So how might care be impacted by these changes if implemented largely as proposed?  

Where are patients likely to engage with this information?  How about providers?

Patients, to date, have shown little interest in actively engaging with their health care data on their own (consider almost every provider’s struggle to get Portal engagement) - what will Medicare/Medicaid patients do with their claims history?  It’s possible applying algorithms to claims data to identify at-risk profiles might generate patient-level demand but the marketing will have to be focused and on point.  

The first real-world test of the data typically available is Medicare’s Blue Button API (now in version 2.0).  As of October, there were 1,200 software developers in the sandbox and 100 - 200 patients had downloaded their data.  It’s possible this gap between developer engagement and patient engagement represents a lag from the time it takes to create an application to generating demand for the information.  I think it also highlights that age-old health care problem of an abundance of data and little of it valuable or comprehensible to your average individual. At the end of the day, how do you engage a patient to make their best health care choices when those choices are either deeply complex or rarely and erratically occur?

The other audience, of course, is providers.  Claims data provides a history of activity which can complement the clinical care history each participating provider can access.  They can see diagnoses and procedures which both carry useful information in any given provider’s ongoing care of the patient and supplement their clinical inquiries.

The second benefit of having access to claims data is in optimizing HCC scores.  Since a primary input of HCC scores are all the diagnoses a patient accumulates during the year, having access to a comprehensive list of billed diagnoses allows for any given provider to potentially optimize the patient’s HCC scores.  If this market evolves, payors could fully decentralize HCC scoring (with appropriate incentives) to providers. Considering the HCC score paradigm is national, and zero-sum, it can be expected there will be a rush to claim this space and a handful of winners should emerge.

The health care market continues to be pushed to evolve as the population ages and inflation marches on.  You should consider the technology companies you work with and ask if they have the history, the people, and the capabilities to help you navigate a market where changes can dramatically impact your bottom line and your outlook.  At pMD, through our expertise in mobile charge capture, secure clinical communications, and care navigation we strive to meet our customers where their future needs live.  See what we are about at

Related Articles:

Interoperability in Health Care IT: The New Norm… Eventually
The Goal of Interoperability in Health Care: Uniting People & Systems

To find out more about pMD's suite of products, which includes our MIPS registrycharge capturesecure messagingclinical communication, and care navigation software and services, please contact pMD.

Apple. When you hear that word, do you think of the fruit that keeps the doctor away…or of the first company worth more than $1 trillion?

With over 700 million iPhones in use globally and 400 phones sold every minute, Apple is a relatable name to almost anyone. In fact, there is a popular YouTube video showing a 1-year old child successfully navigating an iPad, and then trying unsuccessfully to “swipe” a magazine page. How did a company that almost went bankrupt in 1997 become so relevant today?

Application Programming Interfaces

Innovation - Steve Jobs once said: “Innovation distinguishes between a leader and a follower.” Following the success of the iPod, Apple introduced the world to the touchscreen iPhone, establishing the company’s identity as an innovator. Apple continued to innovate by integrating different industries with its products through applications in the App Store. Most recently, Apple’s focus has been on advancing the health care industry by incorporating new application programming interfaces (APIs) for developers to work with.

For those new to APIs, imagine a fire hydrant. A fire hydrant limits how a fire truck can connect to a city’s water supply by regulating hose connection types. In a similar fashion, an API (hydrant) is a gatekeeper that sets guidelines on how a mobile application (fire truck) can interact with certain information stored on a device (water).

How is this related to health care?

Apple first began dabbling in health care with the introduction of HealthKit in 2014, which enabled users to download personal patient records from the Epic EHR. Then in 2015 and 2016, Apple released ResearchKit and CareKit respectively, improving data collection for researchers and enabling developers to create apps for day-to-day care. All three of these “kits” include APIs that expand a developer’s ability to work with patient information. In a bold move, Apple most recently introduced the new Health Records API.

Why is this new Health Records API a major milestone?

Before highlighting the benefits, it’s important to understand what this API targets. Over the past decade, one of the biggest changes to health care in the U.S. was the American Recovery and Reinvestment Act, which required all health care providers to adopt and use some form of electronic medical records (EMR) by January 1, 2014. As one can imagine, out of this mandate arose a myriad of competing EMR and EHR (electronic health record) systems - two of the largest and most recognizable being Epic and Cerner. With the countless number of EMR/EHR systems, cross coverage of patient information can be a nightmare. To mitigate some of the compatibility issues, an organization called HL7 was formed to create standards for compatibility across different platforms. The latest standard created by HL7 for transferring health care information between systems is called FHIR. Despite this FHIR standard, the problem of a comprehensive patient record remained.

Apple’s latest Health Records API seeks to alleviate some issues with sharing patient information. The API enables users to download personal patient data onto their phones using the FHIR standard. The impact of this API is significant due to numerous partnerships that Apple established with hospital and health care systems. In January 2018, Apple began a pilot program with 12 hospitals including prominent names such as Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine, Rush University Medical Center, and Cerner Healthe Clinic. To date, Apple has increased that number to over 80 participating hospitals.

As the list grows, so does the ability for patients to download and aggregate patient information on their phones. The benefits of providing a central node of information begin with empowering patients to understand and ask more questions about the care they are receiving. Using the API has other benefits - a patient on vacation is admitted to the ER because she has trouble breathing. Having no way to immediately access the patient record residing within her regular care network, an ER doctor would have to rely on intuition and experience to treat the symptoms. With the new Health Records API providing access to EHR systems, the patient could instead open an app on the phone and show the doctor any record of asthma, allergies, and medication that is pulled from her care network - and that right there could drastically improve her treatment!

Similar to Apple, pMD is focused on building innovative products that improve patient care and save lives. As new ways to manage patient information emerge, pMD will remain dedicated to keeping up-to-date with and leveraging the latest technology.

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.