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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.

POSTS BY TAG | interoperability



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 www.pmd.com.


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.





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.

Imagine, if you can, a world where medical information crosses boundaries - safely, reliably, timely, as effortlessly as water. What is required to create such permeable boundaries? Sure, there are the base technical requirements. System B must be able to read, understand, and digest System A’s output. As convoluted as medical information standards can be, there are reliable pieces there. Reliable yet limited.

So, to achieve something more dynamic, deeper, and more useful, what is required?  I think trust plays an outsized role. I am not talking about the trust inherent in the security profiles of each system, though that is important. I'm talking about the trust of the people involved. The human element.  You need to know who you are working with, what they are about, and establish if they are on the same page.

At pMD, we actively seek out partners with whom we can achieve richer technical connections as well as dynamic personal collaborations.  A recent example is the links we are building with a regional EMR company called iMed.  iMed reached out to us last year as they were assessing partners to perform the MIPS registry role for their customers.  Their dream was to create a new module in their software allowing their customers to collect quality data as they entered clinical data into iMed. This made a lot of sense. Capturing quality data in real time would help their customers achieve their MIPS reporting goals and set them up for ongoing success as the medical market continues to reach towards measurements beyond the raw financial value of services.

We met their team, shared what pMD does and what they needed and found a compelling fit.  As they developed this new module we worked closely with their team to share what registry reporting requires so they could consider those requirements in their software.  Finally, we attended their user group meeting, spoke with their customers alongside their team to better link their customers, the module, and pMD’s MIPS registry services together.

We are currently rolling out version one of our collaboration, which allows for regular data uploads from our now mutual customers into pMD, sharing that data back with the reporting providers, and targeting gaps and opportunities for improvement.  The goal is to fully automate this process this year.

It has been a rewarding and productive collaborative effort to create real interoperability between iMed and pMD, for the benefit of those providers using both systems. This type of work is part of fulfilling our mission to make doctors happy and we hope for many years working with our friends at iMed and others who want to create more vital, dynamic, and trusting health care data ecosystems.

 If you'd like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.
We live in exciting times where information can travel instantly across the world in a blink of an eye. With iPhones, smart cars, and even Wi-Fi toasters that can 'print' the daily weather onto your toast, we are literally immersed in the information age all day, everyday. It's this information-sharing world that allows pMD's charge capture, secure messaging, data exchange, and care communities to thrive by connecting doctors with doctors, doctors with office staff, and even doctors with patients! We take pride in our ability to collect patient information from multiple sources (hospitals, billing systems, call centers, etc...) and giving our providers instant access to this real-time data. Our users spend less time with manual entry and instead, spend more time on more meaningful tasks - like seeing patients! So why are there still organizations that seemingly go out of their way to inhibit knowledge sharing?

I've worked with my fair share of big organizations over my many moons here at pMD. It's interesting to see the drastic differences from a well-run, forward-thinking organization to an old-school "no one will ever be allowed to touch my data" group. Sure, there are some government mandates requiring some minimum level of interoperability, but it's surprising to see how many companies put up artificial roadblocks to stop this sharing of information. One example I experienced was with a group of doctors not being allowed to access certain data - on their own patients! They were recently acquired by a hospital, and thus hospital employed. The doctors were allowed to manually enter information into pMD directly, but the hospital refused to work on an interface project to save their doctors from this manual work. To reiterate, these were their own patients! These doctors are still utilizing pMD, but needless to say, the project went nowhere.

Other roadblocks I've seen are HEFTY HEFTY price tags given to interface projects, which obviously shut down the project as soon as the discovery call ends. It boggles my mind how organizations can ask for tens of thousands of dollars to flip switches to send us data. Technical details aside, these "standard price tags" for projected work are positioned as if it was a brand new interface. But let's get serious: software companies don’t reinvent the wheel each time, because that's just not economical. So why the big price tag? The work hours simply don’t justify it.

Thankfully, these organizations that seem to be sharing-averse are not the norm. I'm glad to have worked with many, many groups who, like pMD, strive to make the doctors’ lives easier through technology. Shout outs to St. Petersburg, Florida and Cincinnati, Ohio as having some of the more forward-thinking hospital IT organizations out there! I wish everyone else would get out of the secret-data age and join us in the present. Perhaps we can start listing them online. I wonder if groupsstuckinthedarkages.com is taken...