Doximity is the largest medical network with one in three U.S. physicians as members. Physicians use Doximity to instantly connect with other healthcare professionals, securely collaborate on patient treatment, grow their practices and discover new career opportunities.
Its vision is a future where medical communication is effortless — fast, simple, seamless and secure. Its mission is to “help physicians transcend the fragmented U.S. healthcare system and succeed in the care for their patients.”
Doximity was founded by Jeff Tangney, co-founder and former COO of Epocrates (EPOC), and launched in March 2011. Based in Silicon Valley, it’s backed by Emergence Capital Partners, InterWest Ventures, Morgenthaler Ventures (now Canvas Fund), Draper Fisher Jurvetson, T. Rowe Price and Morgan Stanley Investment Management.
Here, Alexander Blau, MD, vice president of physician marketing and medical director for Doximity — responsible for marketing and user acquisition teams oversees the development of clinical programs, including a socially curated medical literature filter and case-based discussion forums, manages the aggregation, analysis and product integration of diverse healthcare data in charting the first-ever nationwide clinical expertise map — discusses the company, its future and what he’s seeing from his perch.
Give us the short story on what you do and how you came to health IT?
My background is as an emergency physician. During my training, I was drawn to the latest in mobile health technology and eventually built my own app for medical interpretation. From that moment, I knew I was hooked on health tech. Three years ago, I joined Doximity to join a larger team to develop yet more tools that help doctors practice medicine every day.
Tell me about Doxmity. There’s been some press lately about how it’s really innovating the space. What are you doing that makes for such success? Care to share the secret sauce?
Doximity is the first health tech company really built for physicians — as opposed to hospital administrators, billing departments, etc. In just three years, we’ve grown to be the largest network of verified physicians in the US, thanks to our focus on what doctors truly need from technology. Our focus on doctors is the secret sauce.
What are some of the misconceptions you face? Obstacles you must overcome?
There’s a misconception that physicians aren’t technology savvy, which is absolutely not true. Doctors have been among the earliest adopters of all kinds of communication technologies starting with pagers and the first smart phones. When it comes to social media, doctors are necessarily skeptical about privacy and HIPAA compliance. The great thing is that Doximity is specifically built to address physician privacy requirements and enable them to communicate professionally on the mobile devices they rely on.
After a five-year contraction in employer healthcare spending growth, medical inflation in the U.S. is projected to rise to 6.8 percent in 2015, according to PwC’s Health Research Institute (HRI). In its annual report, Medical Cost Trend:Behind the Numbers, HRI projects that the stronger economy is now reaching the health sector, releasing a pent-up demand for care and services. Despite some higher utilization and the cost of expensive new cures, the higher expected growth rate in 2015 is modest compared to the double-digit annual increases seen throughout the late 1990s and early 2000s. However, the fact that health spending continues to outpace GDP underscores the need for a renewed focus on productivity, efficiency and ultimately delivering better value for healthcare customers.
Confident consumers are spending more freely on healthcare because of the improved economy, as well as increasing numbers of newly insured, and HRI expects that trend to continue through next year. In addition, the high costs of specialty drugs will increase the healthcare spending growth rate, according to HRI. As exemplified by new Hepatitis C therapies, which are estimated to have a big cost impact next year – responsible for a 0.2 percent increase in spending growth – drug development continues to play an inflationary role in the short run. However, over the long-term, these innovative new therapies may improve quality of life and reduce other medical costs. Other inflationary factors identified by HRI are shifts to higher payments for physician practices acquired by hospitals and health systems, and IT integration investments for large-scale health system mergers and acquisitions.
“Due to a demand for value and increased efficiency in the healthcare industry, medical inflation will be modest this year” said Kelly Barnes, PwC’s U.S. health industries leader. “It is still too early to tell whether the drive for transparency and better value for each healthcare dollar – the cornerstone of the new health economy – will be able to temper spending growth once millions of newly insured access the healthcare system.”
The report notes that additional factors are helping to moderate the growth rate. Three factors holding down spending growth include:
• Healthcare providers gaining efficiencies through ‘systemness’ – streamlining administrative activities and standardizing clinical programs to eliminate redundancies and lower operating costs
• Cost-conscious consumer shopping brought about by employees shouldering more of the financial responsibility for their healthcare
• Risk-based contracts in which healthcare providers are held accountable for patient outcomes
After accounting for likely changes in benefit design, such as higher deductibles and narrow networks, HRI projects a net growth rate of 4.8 percent in 2015. Benefit design changes typically hold down spending growth by shifting financial responsibility to consumers, who often choose less expensive options.
Informatica Corporation, the world’s number one independent provider of data integration software, today announced the availability of a new research report by the Ponemon Institute LLC, entitled, The State of Data Centric Security. Based on a global survey of more than 1,500 IT and IT security professionals, the study reveals how organizations understand and respond to data security threats in today’s information-everywhere world.
According to the study:
Not knowing the location of sensitive or private data is the foremost concern of today’s IT security practitioners, topping hacker attacks, malicious employees and concerns around compliance.
Organizations are in the dark regarding sensitive data, withonly 16 percent knowing where all their sensitive structured data resides, and a miniscule seven percent knowing the location of all sensitive unstructured data, including data in emails and documents.
Automated sensitive data-discovery tools would reduce risk and increase security effectiveness. The vast majority of respondents (nearly 75 percent) believe their security activities would benefit from an automated solution for discovering the locations and relationships of sensitive and private data. However, only 40 percent of organizations use an automated solution, and only 22 percent of those use it to discover sensitive data in emails and files.
Key Survey Findings
With today’s escalating threat landscape and with sensitive and private data no longer restricted to traditional enterprise boundaries, it is imperative to know data location and proliferation to protect it adequately. According to the Informatica-sponsored Ponemon study:
57 percent of respondents say not knowing where sensitive data resides keeps them up at night, followed by those who say migration to new mobile platforms (51 percent), temporary worker or contractor mistakes (50 percent) and outsourcer management of data (42 percent) are top sleep-robbing concerns.
24 percent do not know where their organization’s sensitive structured data resides, and an additional 60 percent have only limited knowledge.
41 percent do not know where their sensitive unstructured data resides, and an additional 52 percent have only limited knowledge.
Current security solutions often do not provide visibility into data location and user access, while existing data protection procedures are most often poorly conducted.
Electronic health record (EHR) technology has become truly transformative for the healthcare industry; prepared or not, healthcare teams are increasingly relying on new information technologies to improve the delivery and management of care. EHRs have enabled faster and easier access to patient information, and hold the promises of improved workflows, efficient sharing of information across communities and reduced costs for many physicians and hospitals.
But now that nearly 80 percent of physician practices in the U.S. today have EHR systems in place and the Centers for Medicare & Medicaid Services’ (CMS) meaningful use program is well underway, it is time to look to the next stage of health care technology and innovation. Health care teams must now move beyond the first step of digitizing patient records to transforming this valuable data into meaningful and actionable knowledge that will help care teams make more informed decisions at the point of care and ultimately, improve outcomes.
For this impact to take place at both the individual level and at the population level, care teams need to leverage clinical analytics that will provide visibility into important clinical trends across the entire population. For example, being able to review trends in diabetes care or readmission rates across a population represents an opportunity for specific, meaningful change to improve care delivery and outcomes.
For a practicing clinician, “population health management” means being able to see where an individual patient is within the clinician’s or clinic’s population (e.g., whether the individual’s chronic condition is above or below population benchmarks) and to take action at the point of care, as well as being able to refer to relevant population health metrics.
For a patient, clinical analytics presumes trust, not only in the competency and care of the physician, but also in the security of his or her information. Population health management and analytics tools must ensure that patient information can be gathered, stored, and used in a way that is demonstrably secure.
Care teams should consider four key elements when exploring clinical analytics tools for population health management:
Guest post by Dane D. Hallberg, strategic advisor, M3 Information.
Hospital readmissions continue to be a major contributor to soaring healthcare costs and a drain on the U.S. economy. According to the Robert Wood Johnson Foundation, 4.4 million hospital readmissions account for $30 billion every year, while 20 percent of Medicare patients are expected to return to the hospital within 30 days of discharge. The Affordable Care Act of 2010 requires the U.S. Department of Health & Human Services to establish a readmission reduction program.
This program provides incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. Centers for Medicare and Medicaid Services (CMS) has created quality programs that reward healthcare providers and hospitals with incentive payments for using electronic health records (EHR) to promote improved care quality and better care coordination. The reasons for hospital readmissions include adverse drug effects (ADE), lack of a proper follow-up care, inability of patients to understand the importance of their medications and diagnoses, unidentified root causes, and misdiagnosis. Technology could play a vital role here by properly documenting, tracking, diagnosing, monitoring, and enabling better communication between patient and provider.
Adverse drug events constitute the majority of hospital readmissions. A cohort study, including a survey of patients and a chart review, at four adult primary care practices in Boston (two hospital-based and two community-based), involving a total of 1202 outpatients indicated that 27.6 percent of these ADEs were preventable, of which 38 percent were serious or fatal. Human error was the leading contributor to these ADEs, followed by patient adherence. Additionally, patients who screened positive for depression were three times as likely to be readmitted compared to others.
Our analysis indicates that 28 percent of adult hospital stays involved a mental health condition. A study of Medicaid beneficiaries in New York State determined that, among patients at high risk of rehospitalization, 69 percent had a history of mental illness and 54 percent had a history of both mental illness and alcohol and substance use. We know that a properly implemented mental health screening protocol can lead to effective diagnosis, and that proper management of these issues can positively impact the reduction of hospital readmissions.
Further studies show that most cases of readmissions for certain chronic conditions have an underlying mental health issue, which appears in patients who have not been previously diagnosed for a mental health condition (i.e., anxiety, bipolar disorder or depression). For example, anxiety and/or depression increases the risk of stroke and decreases post-stroke survival, and plays a key role in diabetes treatment as 33 percent of this patient population is found to be depressed and patients with bipolar disorder have reduced life spans. Other cases where depression affects the patient’s survival and treatment cost include hypertension, stable coronary disorder, ischemia, unstable angina, post myocardial infarction and congestive heart failure.
An important point to note: congestive heart failure is the major driver of hospital readmissions in the U.S., accounting for 24.7 percent of all readmissions. Another study concluded that patients with severe anxiety had a threefold risk of cardiac-related readmission, compared to those without anxiety.
Guest post by Paul McRae, director of business development, healthcare, AirWatch by VMware.
The evolution of mHealth has caused a dramatic increase in the use of mobile devices across the healthcare landscape. Mobile innovations are now positioned to vastly improve both the quality and quantity of the lives of human beings. New technologies and applications are helping organizations lower costs and provide higher quality service to patients. Mobile deployments in the healthcare industry enable clinicians and healthcare IT professionals to access medical records, diagnose illness, integrate with existing providers, enhance patient engagement and improve EHR interoperability.
As EHRs and the growth of deployed mobile devices and apps become increasingly popular, the need for mobility management and security is paramount. To embrace mobility, healthcare organizations must provide secure, easily accessible apps for staff and IT departments must manage devices while remaining HIPAA compliant and protecting patient records.
Enter containerization, an emerging class of management tools that carve out a separate, encrypted zone on the user’s smartphone within which corporate apps and data can reside. Policy controls apply only to what’s in the container, rather than to the entire device. Mobile containerization offers a way for hospitals to securely deliver apps and data to clinicians without interfering with the users’ ability to access their personal content.
Currently, the end user is divided into two separate personas – the personal and the corporate. Duality provides two different levels of security for very different forms of information present on a device. For example, the corporate security measures might require compliance with federal or HIPAA regulations, a form of monitoring that would be seen as invasive to employee privacy.
Mobile platforms are beginning to integrate containerization into their frameworks, which allows for more secure and tighter amalgamations of data with their corresponding operating systems. OEM’s are placing containers for work use with the underlying OS for greater efficiency, better feature support and improved user transparency. This embedded form of containerization allows IT to maintain consistent security policies to mitigate threats on every mobile device, from smartphones and tablets to laptops, peripheral devices and emerging machine to machine (M2M) technologies.
Containerization allows healthcare organizations to remain compliant with the stringent security requirements they must meet, while providing employees a consistent user experience across multiple platforms. However, each mobile operating system presents its own security challenges, such as Web-based malware or the ability to download apps outside of designated app stores. Securing corporate information that has been accessed on personal devices from applications and content repositories remains a major challenge, especially to ensure data loss prevention (DLP) if the device is stolen or the employee leaves the organization.
Guest post by Ken Perez, vice president of healthcare policy,Omnicell.
Accountable care organizations (ACOs) are primarily associated with Medicare or commercial payer-led arrangements. However, the Affordable Care Act (ACA) also authorized limited demonstrations that allow states to test Pediatric ACOs from 2012-2016. In addition, the Centers for Medicare and Medicaid Services (CMS) has provided guidance letters to several state Medicaid directors on how to implement integrated care models, which may include ACOs, in their Medicaid programs.
With this encouragement from CMS and the need to rein in Medicaid spending—which is generally increasing due to the ACA and is shared by the federal government and states—it is estimated that about half of the states are at some stage of planning Medicaid ACOs.
This emerging trend runs counter to a couple of the conventional caveats about ACOs—they won’t scale to handle large populations, and they won’t work with patients who are economically disadvantaged.
However, these caveats are being challenged by the experiences of Colorado, Utah and Oregon, respectively, as well as the plans for North Carolina’s Medicaid ACO program.
Colorado’s Accountable Care Collaborative (ACC) has been in existence since 2011 and today has more than 350,000 members, almost half of the state’s Medicaid population. The ACC has focused on connecting members with their primary care physicians, using care coordinators, and leveraging analytics extensively.
According to the report on the ACC’s most recent fiscal year, which ended in June 2013, the program generated gross savings of $44 million, returning $6 million to the state after expenses. It accomplished this in part by reducing hospital re-admissions by between 15 percent and 20 percent and decreasing the use of high-cost imaging services by 25 percent versus a comparison population prior to implementation of the program. In addition, relative to clients not enrolled in the ACC program, it slowed the growth of emergency department utilization, lowered rates of exacerbated chronic health conditions (e.g., hypertension by 5 percent and diabetes by 9 percent), and reduced hospital admissions for chronic obstructive pulmonary disease patients by 22 percent. Most importantly, Colorado has seen improved health for the ACC member population.
Guest post by Michele Hibbert-Iacobacci, CMCO, CCS-P, vice president, information management and client services, Mitchell International.
The International Classification of Diseases – 10th Revision, Clinical Modification and Procedural Coding System’s (ICD-10-CM/PCS) implementation in the United States is being delayed yet again. According to the latest polls and surveys, there are many organizations (most who need to use it) that were ready to roll with the new classification on October 1st 2014. The change came about because the Senate approved a bill (H.R. 4302) on March 31, 2014, that delays the implementation of ICD-10-CM/PCS by at least one year and then a subsequent official announcement by CMS announced a forthcoming interim final rule that would set the new compliance date for October 1, 2015.
How will this new implementation date affect Property and Casualty payers and providers? For an industry that was not required to change, P&C was ready to go – mainly because of the dependency on payments and bill processing. The question was, “Will we see ICD-9 and/or ICD-10?”
Fortunately, from a processing perspective the P&C industry was prepared for most anything. Payers were creating processing systems and/or contracting with vendors who considered all possibilities including bills submitted with both codes and the submission of ICD-9 codes well after effective dates. These payers also considered the compliance environment as most are guided at the state level.
As difficult as it may be to be ready for the effective date of ICD-10 just to have it changed, most aspects are positive for property and casualty. Additional time for testing, communication to providers and overall education (external/internal) enhances the readiness for the new date. The negative is the cost – staff has been added and enhanced with testers, educators and coders for the initial date. Maintaining staffing levels for a longer period of time was not accounted for in most budgets. The cost will be higher to implement now and many companies did not plan on the additional timeline.
So how will this shake out moving forward? Providers will likely react by submitting ICD-10 codes to P&C payers before the implementation date of October 1, 2015. Payers will need to make decisions on how they will handle these claims since P&C is not guided by the same rules under HIPAA as the health side. Some payers may decide to turn these claims back to providers and others will translate to ICD-9 for payment. Compliance standards, whereby a state has implemented mandates on the use of code sets that need to be addressed and/or revisited, may also impact the way payers process ICD-10 codes prior to October 1, 2015.
