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.


I had been chatting with a doctor for a while about his hospital rounding and charge capture process and how he ended up with his current practice, when I suddenly had a question for him about the Apple Watch.

We’d been looking at different aspects of pMD together and his excitement about the mobile software kept growing. Meanwhile, we had also swapped stories about Seattle and New York and about the geographical challenges caused by pursuing a career in medicine. On a whim - not certain yet myself if I would get one - I asked him if he was thinking about getting an Apple Watch.

"Ah," he said regretfully, "I don't think I will get one."

I noticed that he was wearing a large, elegant, solid-looking steel watch and asked him about it. His face lit up with pride. "I will be buried wearing this watch," he smiled. "I won it in a race..." He began telling me about his hobby of street-racing BMWs and of his excitement at winning the rally. I could tell that the watch meant a lot more to him than timekeeping or as a fashion statement. It was something that he had earned - a badge of honor.

It made me think about the increasing overlap between the professional and the personal, and also between fashion and technology. We use our own devices to do our jobs better, and we've begun to wear and carry and accessorize these computing devices as they have become more mobile. A watch, more than a phone or a computer, has always meant something different to different people: time keeper, fashion statement, status symbol, memento.

I myself did eventually decide to spring for the Apple Watch - but I wasn't replacing anything. If I were in his shoes, I might also hold off, at least until I had a chance to win an Apple Watch Edition in a street rally!

Here's What You May or May Not Have Missed This Week:

• Centers for Medicare & Medicaid Services (CMS) announced this week that the Pioneer Accountable Care Organization (ACO) program generated more than $384 million in savings in its first two years, without compromise to the quality of patient care. The Department of Health and Human Services has qualified the program for an expansion, and CMS plans to extend the program in the coming years. Source

• The Bureau of Labor Statistics reported that out of the 223,000 jobs added in April, the health care industry was among the leaders with 45,200 new jobs. Hospital employment accounted for more than a quarter of that total with an increase of 11,800, while Nursing homes and residential-care facilities added 8,100 employees. Source

• The White House nominated Karen DeSalvo as the assistant secretary for health at the Department of Health and Human Services. DeSalvo, who joined ONC in January 2014, will continue to fulfill her responsibilities as the head of ONC until she is officially confirmed in her new position. Once confirmed by the Senate, she will leave ONC. Source

On The Front Lines:

This week Apple dipped back down by 0.04 percent in the physician charge capture device wars against Android. In tech news, Apple is reportedly planning to leverage its new ResearchKit, a software medical research platform, to let iPhone users test their DNA and submit their results to researchers via apps.


iOS: 90.41%
Android: 9.59%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's physician charge capture users. Check back next Friday for your dose of our little medical corner of health care news.

Here's What You May or May Not Have Missed This Week:

• A bill that was aimed at accelerating the pace of federal drug approvals was scaled back this week with the introduction of new legislation, which removed many of the most controversial provisions. Critics of the original bill, called 21st Century Cure, included top officials at the FDA and argued that the changes would risk patient safety. The new draft bill represents a less aggressive streamlining of the drug approval process. Source

• The Department of Defense plans to build its own digital service team in an effort to improve federal IT projects and other data problems, and is opening a unit in Silicon Valley. The department unveiled its Cyber Strategy this week, which outlines plans to collaborate with the private sector to improve cybersecurity. Through this new program, the DOD hopes to improve capabilities that will help both the federal organization as well as the wider US marketplace, such as health care and technology. Source

• The Centers for Medicare & Medicaid Services (CMS) has introduced a new five-star ranking system to rate hospitals on patient quality and experience. The star ratings will use data from the Hospital Consumer Assessment of Healthcare Providers and Systems, which measures patient experience at approximately 3,500 Medicare-certified acute care hospitals. The metrics assessed in the ranking system include facility cleanliness, staff responsiveness, and clinician communication. Source

On The Front Lines:

Apple finally broke a five-week losing streak to Android, coming up with a 0.07 percent net gain of the mobile market share among pMD's charge capture physician users. Also this week, Apple met with IBM and announced that as part of their partnership they will deliver iPads with apps that are tailored specifically for seniors. The apps aim to monitor seniors' health, remind them of their medications and doctor's appointments, and connect them to their family and home care services. The program will be piloted in Japan.


iOS: 90.45%
Android: 9.55%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's physician charge capture users. Check back next Friday for your dose of our little medical corner of health care news.

Here's What You May or May Not Have Missed This Week:

• CMS put forth a payment formula reform that will increase hospital inpatient payments by 1.1 percent for the 2016 fiscal year. The increase is down from last year's 1.4 percent raise. By law, CMS must update payment rates for Inpatient Prospective Payment System hospitals every year and must account for changes in the costs of goods and services used by these hospitals in treating Medicare patients. Source

• An analysis found that the overall number of Accountable Care Organizations (ACOs) has increased to 585 at the start of 2014, and that nearly 70 percent of Americans live in a region served by an accountable care organization. Approximately 5.6 million Medicare patients, or 11 percent, will receive their health care from an ACO this year. Source

• A controversial bill that would limit "personal belief" exemptions to school district vaccination requirements passed in a 7-2 vote this week and will now go before the judiciary committee for review. A study was also released this week by the Journal of the American Medical Association that showed even more evidence that childhood immunizations are not linked to autism. The recent surge in number of measles cases puts pressure on public health officials and lawmakers to boost vaccination rates and end exemptions. Source

On The Front Lines:

For the fifth week in a row, Apple has lost mobile market share to Android among pMD's physician charge capture users. To Android's glee, Apple's 0.11 percent loss this week puts the total drop at 0.38 percent. The first shipment of Apple Watches arrives in stores today, and with it are more than 3,000 new third-party apps for the new smartwatch.


iOS: 90.38%
Android: 9.62%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's physician charge capture users. Check back next Friday for your dose of our little medical corner of health care news.
Apple will report their Q2 FY15 Earnings on Tuesday, April 27th, so it’s time for us to ever-so-loosely hypothesize how Apple market share has fared based on the technology trends among our niche of physician Apple users.

Q1 was a record breaking quarter for Apple, who posted the biggest profit in corporate history largely due to the success of iPhone sales. Last quarter we saw a mild increase from Android physician users despite Apple’s phenomenal iPhone growth. This quarter, Android users again showed slightly more net growth than Apple, climbing up 0.12 percent.

Apple’s earnings from Q2 should indicate just how successful the iPhone 6/6 Plus phones have been performing, as well as the adoption of the new MacBook that was released this quarter. Let’s take a look at what’s been happening with the iPhone growth by model among our users this past quarter.

Users are finally turning in their iPhone 4 and 5 devices and investing in newer models, which is great for Apple. Given the substantial increase in iPhone 6/6 Plus devices over the past quarter, both from upgrades as well as new users, we’re anticipating that Apple will post sound Q2 earnings with a resulting uptick in stock value. We’ll call it more of a hunch. Apple just released pre-orders for their Apple Watch with orders nearly topping 1 million, so we’re likely to see the impact of this innovative new gadget in Q3 earnings. Until next quarter!

Here's What You May or May Not Have Missed This Week:

• The Senate approved bipartisan legislation this week to permanently replace Medicare's highly unpopular Sustainable Growth Rate (SGR) formula. The ongoing Congressional actions for this bill go back as far as February 2003. The bill will increase Medicare reimbursement rates for physicians and will also extend the Children's Health Insurance Program for two more years. Health policy experts hail the bill as a move toward pay-for-performance reimbursement rather than fee-for-service. Source

• CMS has imposed a record number of Medicare Advantage fines in the first quarter of 2015. The agency has focused on cracking down on bad practices among Medicare Plan Sponsors, and almost $2.5 million in civil money penalties have been collected so far this year. CMS has the authority to take contract action if they determine that a sponsor fails their requirements or no longer meets the applicable conditions of the program. Source

• A new study found that the growing amount of paperwork involved in patient visits may cause patients to avoid visiting a doctor or hospital altogether. Participants in the survey reported that paperwork cuts into the time the clinicians spend with patients, and the majority would rather search for treatment on non-life-threatening issues on the Internet than deal with health care paperwork. Source

On The Front Lines:

Apple took a tumble this week among pMD's physician charge capture users, losing 0.11 percent of the mobile device pie to Android. Users may be focused on the Apple Watch, which drew in nearly 1 million pre-orders for the new device since last week.


iOS: 90.49%
Android: 9.51%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's physician charge capture users. Check back next Friday for your dose of our little medical corner of health care news.

The highly anticipated Apple Watch opened to the public last week for pre-order, drawing nearly 1 million people to place an order for the wearable gadget. The cutting edge device not only presents a new fashion statement for the tech-centric, but it also opens the door for innovative software development for its users. Doctors can expect great things to come from the iWatch, which will help with point of patient care services and overall daily efficiencies.

Accessing and sharing medical information from a watch during a patient visit is certainly less intrusive than a computer, tablet, or smartphone. And although smartphones are continuing to grow in physical size each year, they still seem to get lost in our bags, backpacks, cars, hospital rooms… you name it, you can probably lose a phone in it. The smartwatch changes everything because it’s always accessible and far less cumbersome. Doctors can dictate into the device to record information, make calls, and send messages (secure messages, of course.) The Apple Watch has the potential to transform the way HIPAA compliant messages are sent and received.

The new app interface also opens the floodgates for iWatch apps - both from current apps syncing to the device, and brand new smartwatch apps altogether. App notifications and alerts will come through the watch and vibrate or tap you on the wrist, making reminders more powerful and less likely to be missed or ignored. It could actually help doctors stay on schedule! The Apple Watch doesn’t have a camera (yet), but users can display photos and medical images on demand.

Apps that already allow doctors to easily access medical information from their mobile devices can link their app to the watch for an even more mobile and hands-free option. Doctors could track their patient list, pull drug information for dose guidelines, capture their patient encounter charges, dictate patient orders, and even document their notes, all from their wrist. The potential for the Apple Watch for health care providers is powerful and the onus is on medical software companies now to utilize the innovative technology that Apple has developed.

Here's What You May or May Not Have Missed This Week:

• The Centers for Disease Control and Prevention (CDC) launched a new social media initiative this week in an attempt to highlight the consequences of prescription drug abuse and overdoses. The campaign, "When the Prescription Becomes the Problem," tells the stories of people who have been affected by prescription painkiller abuse and are working to improve their lives. According to the CDC, there were 16,235 deaths involving prescription opioids in 2013 alone. Source

• Ebola researchers announced a breakthrough in their testing against the virus responsible for the deadly outbreak in West Africa. Two new Ebola vaccines protected lab monkeys against the virus, requiring only one dose of the vaccine and without apparent side effects. The vaccines have not yet been tested on people, but safety trials among healthy volunteers are expected to begin early this summer. Source

• The White House reported this week that it will enlist the help of hospitals and medical professionals to fight the health risks associated with climate change. They stated that "rising temperatures can lead to more smog, longer allergy seasons, and an increased incidence of extreme weather-related injuries." The announcement aims at building a health care infrastructure that is resilient to the adverse health effects of climate change. Source

On The Front Lines:

Apple lost a total of 0.08 percent of the mobile device pie to Android this week, making that three weeks in a row now that Apple has lost market share. Users may be focused on the Apple Watch instead, which can be pre-ordered starting today. Apple will also be taking in-store appointments to let users try on the watch in-person.


iOS: 90.60%
Android: 9.40%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's physician charge capture users. Check back next Friday for your dose of our little medical corner of health care news.

As smartphone technology in the health care market becomes more innovative and cutting edge, its consumers have become increasingly more tech-savvy. There’s also more awareness that smartphone devices and software can be updated on an ongoing basis after purchase; however, the notion that devices should be updated is still largely under-adopted in the medical community. It’s common to hear the phrases, “I don’t like the way the new version looks,” “I don’t want to learn another new system,” or “I don’t have time for this.” These statements miss the mark on a key point in mobile software: some of the most important enhancements in updates go far beneath the visual surface and could be violating electronic health care laws.

Apple found 53 major security vulnerabilities in older iOS 6 and iOS 7 versions that the company has since patched in iOS 8, its most recent mobile operating system. Apple released iOS 8 on Sept. 17, 2014, and so far 78% of Apple mobile devices are using iOS 8. The remaining 22% of current users are still susceptible to these security vulnerabilities.

How does this affect the millions of health care professionals using their mobile devices for their work? Well for one, not keeping up-to-date software means they’ll miss out on the latest and most beneficial app features that could help with patient care and productivity. But more seriously, ‘update delinquents’ run the risk of being in violation with HIPAA Privacy and Security rules. Under HIPAA, Covered Entities are required to “implement policies and procedures to prevent, detect, contain, and correct security violations (45 CFR 164.308)” for electronic protected health information (ePHI). Furthermore, HIPAA Security and Privacy Rules require that all Covered Entities protect the ePHI that they use or disclose, and recommend, among other precautions such as encryption technology, installing and regularly updating virus-protection software on all portable or remote devices that access ePHI.

Without iOS 8, attackers could intercept user credentials and saved passwords on Safari, install unverified and malicious apps, access text messages and email attachments without authorization, or bypass the screen lock feature altogether, to name a few security vulnerabilities.

Below are five tips to protect and secure the electronic health information on your mobile device:

1. Keep your software up to date! Install security software for added protection.
2. Use a complex password or other user authentication on your home screen.
3. Install and activate remote wiping and/or remote disabling, like Find My iPhone.
4. Research mobile apps before downloading them.
5. Be cognizant of where you leave your mobile device.

Apple’s app submission rules now require that developers use the iOS 8 software kit for new and existing app updates. This means that if you’re running anything lower than iOS 8 on your Apple device after June 1, 2015, you won’t receive updates to your apps. Although Apple won’t remove any apps currently in the App Store, users running iOS 7 or lower won’t be able to download new features or “bug fix” updates. It’s a nudge in the right direction to get the remaining 25% of Apple users onto iOS 8. And for the population of medical professionals who access electronic health data from their mobile devices, including our charge capture and secure messaging users, there are no more excuses for running out-of-date versions. So, if you’re guilty of ignoring software updates or simply can’t remember the last time you updated your iPhone, it’s finally time to update your device to iOS 8 (and every other update thereafter!).

Here's What You May or May Not Have Missed This Week:

• This past Thursday, CMS and the Office of the National Coordinator for Health IT (ONC) announced a partnership that will give participants of the State Innovation Models initiative access to new online tools and resources to improve their health systems. The federal effort aims to advance states' usage of health information technology, health information exchange, and interoperability. Source

• The White House released a plan to combat antibiotic-resistant infections from contaminated medical devices, in light of the outbreaks linked to the contaminated duodenoscopes and endoscopes. The Centers for Disease Control and Prevention (CDC) hopes to slash rates of the deadly superbug by replicating a research program that saw successful results among four Chicago hospitals. Source

• Google and Ethicon, a medical device company and Johnson & Johnson subsidiary, have partnered to build a cutting edge platform for robotic surgery. The companies aim to develop new robotic tools for surgeons and operating room professionals, including improved medical device technology, robotic systems, imaging, and data analytics. Source

On The Front Lines:

Apple lost yet another piece of the mobile device pie to Android this week among pMD's charge capture physician users, with a 0.03 percent slip. Today also marks the fifth anniversary of when the iPad first went on sale in 2010. Since Apple released the revolutionary tablet, almost 250 million have been sold and the device has evolved to be thinner, faster, and better.


iOS: 90.68%
Android: 9.32%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's physician charge capture users. Check back next Friday for your dose of our little medical corner of health care news.