PokitDok Announces the Release of Pharmacy APIs

By Nicole Fletcher,

 

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Being able to look up pharmacy benefits is hard. When the time comes to write a prescription, doctors have no way of knowing what medications are covered under a member’s insurance policy - and patients have no idea if a scrip will be covered until they’re through the pharmacy checkout line. While strides toward transparency have been made in recent years, we believe in software - and the ability to power a better experience for all parties involved.

That's why, live from ATA in Minneapolis, PokitDok is excited to announce the release of our Pharmacy Benefits Solution, a series of APIs built to power real-time insight into formulary and benefit information. Pharma was a natural next step for the PokitDok team - and we've worked hard to apply the best in modern software to simplify this complex, silo’d space.

PokitDok now gives access to a consolidated view of patient prescription plans, qualified formularies, in-network pharmacies, and related financial information. This level of real-time digital access can enhance a medical visit with more informed treatment plans, whether appointments take place in person, or through a telemedicine visit.

To learn more about this launch:

 

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider

How Most Patients Find a Doctor — And How That’s Changing

By PokitDok Team,

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The inspiration for this post came from a pretty straightforward question: How does the average American find a doctor? That question has more layers than you might think. If you move to a new city for work, how do you choose a primary physician? If you need to have a specific procedure done, how do you find a surgeon you can trust? How do you assess the care provision of the local doctors available to you?

When we began to dig through the research, two things jumped out immediately:

  • There are far more articles by doctors teaching patients how to find a physician than there is available research on how real-life patients behave.
  • There is a noticeable generation gap in the way patients shop for doctors.

Here is a snapshot of how patients are shopping for healthcare professionals in 2016, and how we can expect that to continue to change in the months and years to come.

Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Consumer, Provider

Three Big Ideas Shaping the Future of Health Informatics

By PokitDok Team,

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Long relegated to the back office, health informatics has assumed a new role at the forefront of American healthcare. Hallelujah. Data, record-sharing and having systems that can actually talk to one another, #interoperability, are the keys to unlocking healthcare data and redefining the future of healthcare.

Dr. William Hersh, a professor of health informatics at the Oregon Health & Science University noted last year on his blog, The Informatics Professor, about how this shift seemed obvious to him and others in the field. He also made a point to say, not surprisingly, that much of the industry is still playing catchup. "Informatics is in the mainstream of healthcare now, and healthcare recognizes that using data and information to improve processes and outcomes while reducing costs is an essential part of doing business," he said. "Clearly there is room for improvement in how operational informatics is being done, but there is no turning back. This means that the priorities for our field are now driven largely by forces external to it. This is not necessarily a bad thing, as we must adapt to play our role optimally for the greater benefit to healthcare."

We couldn't agree more, Dr. Hersh — and our data science team indeed dreams about such validating sentiments. In the spirit of health informatics and data science, we thought we'd take you through a few external forces driving the field and offer a few techie deeper dives brought to your straight from our dev blog, Full Metal Health. We will explore:

  • The still-unmet need for health systems to work together and to share records seamlessly
  • Emerging applications for health records themselves
  • Patient empowerment through consumer-grade technology (and occasionally homemade tech)

Here is a look into how those forces are shaping the future of informatics.

 

Transparency & Interoperability

Billions of taxpayer dollars have been spent to ensure the digitalization of health records. Issues arise, however, in the movement of said records from and across multiple systems. What happens in turn is that most EHRs or PMS in use today function as walled gardens, from which those records cannot escape or move. Our platform is built to ensure interoperability across all of those systems, thereby freeing the data for transfer, free use and analysis. We did a little digging to see what other people thought:

Patrick Caldwell reported in MotherJones why the vendors of these systems have such an incentive to keep health records within their proprietary silos. These walled gardens are a great way to lock healthcare providers into expensive data ecosystems. This lack of interoperability also causes problems for patients, who cannot easily send their health records from their primary care doctor to their local hospital in an emergency. Why, you ask? It's simple: Because the technologies don't speak the same languages.

"Working in data silos will not improve the exchange of health data; rather, it will create friction in the industry," said Jitin Asnaani, Executive Director of CommonWell Health Alliance, in the Electronic Health Reporter. "Patients expect their doctors to have the information they need to provide them with the best treatment. Doctors struggle to access this important data outside their four walls. The industry has an opportunity to step up and make it possible for providers to access a three-dimensional view of the patient's health history, and in turn, create a new wave of opportunities for the health IT industry."

Infosys EVP of Healthcare, Insurance and Life Sciences Dr. Manish Tandon argues in Healthcare IT News that overcoming this hurdle would be nothing short of revolutionary. He paints a picture of a connected care system in which a diabetic patient showing hypoglycemic symptoms could count on paramedics to respond within minutes thanks to a biometric wearable that communicates with the paramedics' own system.

That reality, however, is still some way off. Tandon writes: "While it is important to adopt the right technology, it is equally essential to build an ecosystem that can enable a connection among all these elements. With a strong infrastructure, this Connected Care approach will take root and have the foundation on which physicians, pharmaceutical and medical companies and payers can connect and leverage the data the devices generate and collect."

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New Approaches to Health Data

Patients are discovering quickly that having their health records siloed and accessible only to select providers limits their healthcare options. This is precisely why we have built our API platform. APIs facilitate interoperability through technologies most people are already familiar with, which makes record sharing both user-friendly and relatively easy to secure. Elsewhere, health informatics professionals are re-imagining how they work with patients' health records.

Consider the personal health record (PHR), which patients have access to, unlike the EHR, which only providers can access. Letting patients be the stewards of their own health records could open the doors to many more consumer-friendly models of healthcare delivery.

One example is local SF startup Gliimpse, which has a built platform allowing anyone (in the US for now) to "collect, personalize and share a picture of their health data." A patient then would not need to rely on third parties — and the regulations to which they're subject — to store and share their data. Another interesting application features HydroAssist, an app that allows patients with hydrocephalus — a cerebrospinal fluid condition — to record, track and share their treatment histories.

These among countless other healthcare informatics companies are working to build interoperability into the entire healthcare system — several of which made our list of innovative healthcare startups to watch this year.

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The Empowered Patient

So far, we've only touched on what may be the biggest factor shaping the future of health informatics: That technology is now sophisticated enough to allow patients to play a greater and more proactive role in their health.

Just this past fall, the team at Open mHealth released their newest open-source app, Shimmer, which weaves things such as nutrition and fitness data into a person's health record. By integrating with consumer devices and services already tracking this information — Fitbit, Jawbone UP, FatSecret, RunKeeper, among others — Shimmer is able to connect all of that data for free. Open mHealth understand the same thing we do: consumers won't wait for a plodding industry to catch up to their demands, and the companies poised to succeed today understand we — ahem, they — need data healthcare informatics to meet these fervent, albeit reasonable, consumer demands.

In fact, a recent example proves such a statement. British citizen hacker Tim Omer, a diabetic frustrated by the expensive glucose monitors on the market, took matters into his own hands and built his own. He has since partnered with a charity, Great Britain Online Diabetes Community, to share his device nationwide — well played, Tim.

As in nearly every other industry, power in healthcare has shifted to the hands of the consumer. This, and only this, is the way of the future, writes healthcare business advisor and PokitPal Lisa Suennen. "Those companies who will end the game with the biggest prizes will be those that have embraced the idea of engaging with patients in product conceptualization, clinical trial design and, especially, through creating a continuous feedback loop with consumers/patients through monitoring, personalization and responsiveness to patient-reported outcomes," she said, and we couldn't agree more.

She went onto note, "The ones sitting on piles of gold at the end of this race will be those who have risen to the leadership challenge of partnering with their customers in a deep and meaningful way" — and we plan to do just that.

images by:
Ian Schneider, Jimmy Mutso, Guillaume de Germain

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider

How Telehealth Can Help Fix America’s Mental Health System

By PokitDok Team,

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Many people with mental illness in America struggle, and have struggled, to get the care they need for any number of reasons. Through the last decade though, telehealth has proven its potential to help by providing affordable, convenient, and private care all through video chat. There is, of course, a long way to go before therapists are able to consult with and deliver care anywhere to anyone, but growth in the future of this rapidly growing field looks bright, to say the least.

Here is a snapshot of a few obstacles facing the mental health industry and how telehealth is poised to reach millions in the years to come. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Enterprise, Provider

Timing is Key: Make the Open Enrollment Period Work for You

By Brooke St. Martin,

First things first, for those not in the benefits administration space, what is Open Enrollment? Open Enrollment (OE) is defined as the period of time in which employees can freely add, remove or edit their benefit packages without needing to provide proof of a qualifying life event or change reason (think marriage, babies, loss of other coverage, etc). After their plan selection is made, the employee can make any changes they please during the remainder of the Open Enrollment window. Once this window of time closes, they must wait until the following year’s annual enrollment or enroll through the use of a qualifying event.

Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Enterprise, Provider

Bringing ICD-10 to the Masses

By Nicole Fletcher,

As promised in a blog posted a few days ago, your ICD-9 <> ICD-10 conversion troubles are over. To give the full announcement, along with a more technical deep dive, is one of our backend data engineers, Ghadi Shayban. Take a look at the full post on our dev blog, Full Metal Health or get straight into the documentation.

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider

A Recap of the 2015 Rock Health Summit

By pokitdok,

Being squarely in our busy event season and just off the heels of Rock Health Summit, I wanted to give a quick recap and add a few observations about our recent experience at the Summit before we head into the Health 2.0 Code-a-thon this weekend and Health 2.0 starting Monday.

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Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider

Eleven ICD-10 Codes You Won't Believe & a Solution for the Transition

By Nicole Fletcher,

ICD stands for International Classification of Diseases’, and is a system set up by the World Health Organization (WHO) to track global mortality statistics. While the previous version, ICD-9, had only 13,000 billing codes, there are now 68,000 with the October 1st ICD-10 update. The goal of this evolution is to streamline billing processes, help overall population health, and reduce healthcare costs as a whole.

All providers now need a simple way to convert claims from the ICD-9 format to ICD-10. In most cases, this is not a direct mapping and therefore, tends to be a manual, time-intensive process. If providers don’t make this shift in a timely manner, they may face returned or incomplete claims submissions, which means, you guessed it, they don’t get paid.

In honor of this change, we thought we’d offer some relevant entertainment - along with a solution - from our back Pokit, to yours.

Without further ado, here are the 11 most insane ICD-10 codes you won’t believe:

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1.  W56.22 Struck by orca

In case you’re in the mood for a Free Willy-esque jetty run, keep this gem of a code in mind. If for whatever reason, your orca has poor depth perception, you may not be humming the sweet melody of Michael Jackson for long - but you will have a shiny new W56.22 on your record.

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2.  W61.62XD: Struck by duck, subsequent encounter.

Really makes you re-think ‘Don’t Feed The Ducks’ signs right? Who knew it was for our safety and not their waistlines…

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3.  Z63.1: Problems in relationship with in-laws.

Finally. Someone gets it. Never knew it could be a code - but for those of us lucky enough to have a better half (that comes with biological entourage), this makes perfect sense.

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4.  W220.2XD: Walked into lamppost, subsequent encounter.

“Come at me” - lamppost.

SUBSEQUENT encounter? Might there may be a deeper issue if someone is just running around slamming into lamp posts all day?

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5.  Y93.D: V91.07XD: Burn due to water-skis on fire, subsequent encounter​.

Are water skis even flammable? Wouldn’t you just put them in the water if they were indeed on fire? Wouldn’t you also be more likely to be hit by said water ski than burned by it?

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6.  W61.1 Contact with macaw

Let it be known that we’re not trying to contact any macaws - via text, email or otherwise. In fact, we go so far as to avoid pigeons whilst walking on the street. That said, it’s unclear as to who is trying to contact any macaws - but we, and the W61.1, would advise against it.

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7.  W59.21 Bitten by turtle

Evil demons, to be sure.

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8.  W61.32 Pecked by chicken

Ahhh. I get it. They’re conspiring against us!

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9.  V80.2 Occupant of animal-drawn vehicle injured in collision with pedestrian or animal

So you’re saying Santa was injured in a collision between his sleigh, reindeer and the easter bunny? Got it.

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10.  R46.1: Bizarre personal appearance.

We get it. Marilyn Manson is indeed a strange looking human, but does he really need his own, super subjective ICD code?

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11.  W.56.52 Struck by other fish

We’re not entirely sure what the purpose of the word ‘other’ is in this context - but it can’t be good.

 

Wildly entertaining codes aside, ideally, all payers would have been able to accept ICD-10 codes yesterday. If that’s not the case, a subset of claims in ICD-9 may need to be submitted. For this reason, software vendors should make ICD-9 codes available to providers. According to athenahealth, those vendors should also allow providers to code diagnoses in ICD-10, with vendors converting claims to ICD-9 as needed for payers not yet ICD-10 compliant.

It appears we’re in a bit of a transition time and while that may be the case for a while, you’re in luck because we have an API for that. That being an automated ICD-9<-->ICD-10 conversion solution. Read all about it on our dev blog, Full Metal Health - or check out the documentation and get translating.

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider

9 Books On Healthcare For People Who Want To Fix Healthcare

By Natasha Awasthi,

Before this next blog post, we wanted to take a moment to introduce our newest contributor: Natasha Awasthi. Natasha is a self proclaimed digital health nerd and passionate data enthusiast. In this, her first addition to the PokitBlog, she... gives us homework - of the inspirational variety.


 

My professional network is comprised mainly of two kinds of people: those who want healthcare fixed “right now!” and those who wanted it fixed yesterday. I’m a digital health nerd, so this monochromatic nature of my work-related chatter is expected. If you want to join the conversation, or double down on it, then the below reading list is for you.

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The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid

Reid will take you on a tour of other industrialized nations to study, compare and contrast their healthcare offering with ours.

Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Consumer, Dev, Enterprise, Provider

Why Checking Patient Eligibility Is Such A Big Deal

By Nicole Fletcher,

The healthcare industry in the United States is large and complex to say the least. The costs associated with every piece of this expansive system are significant, accounting for a higher percentage of American GDP than the vast majority of other nations. Much of this cost is to due to system wide inefficiencies, which are traceable to legacy techniques and systems for information processing that are outdated and silo’d. The following post will discuss the eligibility piece of the puzzle, touching on why it’s so unnecessarily complex - and what we can do to fix it.

Current Model

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Consumers, i.e. patients, don’t often think about the nuts and bolts processes that take place once they hand their insurance card through the doctor’s office window - but indeed, there are many. Once check-in takes place, the front office has no idea whether or not the card representing a patient’s insurance plan is up to date, or even real. Eligibility checks are hugely important because if a patient is not eligible and the doctor sees or treats him or her anyway, without a self-pay form,  the doctor will likely lose the ability to receive payment from the claim. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider