As health care providers and vendors of electronic health records scramble to implement government rules requiring them to electronically share patient information, some start-ups and their clients are circumventing closed systems and expensive interfaces to mine their patient’s data. Apixio of San Mateo, Calif. is helping doctors piece together a more complete narrative of their patients, by capturing nuggets of information strewn across multiple databases and hidden in consultation notes and scanned documents.
The 700-doctor Muir Medical Group Independent Practice Association, a partner of John Muir Health physician network in Walnut Creek, Calif., is applying Apixio’s search technology in its quest to meet requirements for Medicare patients spelled out under the Affordable Care Act. Those rules reward groups of health care providers by allowing them to keep a percentage of the money they save by treating patients based on outcome, instead of fee-for-service. The task is challenging when a patient’s history is composed of a multitude of notes, as well as lab and imaging tests from different physicians, increasing the chance of duplicate tests, gaps in care, and incorrect coding for procedures.
At Muir Medical, patient notes are contained in NextGen electronic health records. Instead of spending thousands of dollars on an interface between NextGen and Apixio, the IPA uploads patient data from its EHRs to Apixio’s network of servers, or cloud. An Apixio search toolbar will be embedded in its NextGen records.
Mark Musco, the IPA’s chief medical information officer, points to colonoscopy as an example, where patient information can fall through the cracks. The primary care doctor sends a patient for a colonoscopy to a gastroenterologist who either doesn’t use digital records or uses a different vendor. The specialist mails or faxes the results to the primary care doctor, who scans them into the patient’s EHR, and signs off. That report often goes unnoticed, implying the patient never underwent a colonoscopy, and hurting the doctor’s “quality” score.
“The narrative is incredibly rich in data; you get a better understanding of who needs care and who doesn’t. Health care analytics now operate at the coded layer; a huge chunk of patients is left behind,” says Musco, who has been using Apixio since July.
Jonathan Everett, head of IT at Chinese Community Health Care Association, says Apixio’s algorithms have already identified more than $2.5 million a year in uncollected Medicare payments due to improper coding (a number double-checked by internal auditors). A scanned document from the hospital might have a reference to congestive heart failure, but is not coded in a patient’s chart, or a diabetes check-up will omit coding for an eye exam. “Doctors have no incentive to be insanely granular, but for us it’s the lifeblood of what we do,” says Everett.
Shawn Dastmalchi co-founded Apixio two years ago. Previously, he was director of the informatics group at Carl Zeiss Meditec, but saw an opportunity in 2009 after the government passed the HITECH Act, which subsidizes the adoption of electronic health records if health care providers can show “meaningful use.” That includes exchanging patient information. “That part signaled to me that the current dominant players had to open up their system, and new analytics company would be fostered–data aggregation and analytics from third parties,” says Dastmalchi.
Apixio, which has more than 15 customers, has raised $10 million from angel investors, but none from venture capitalists. “The exit strategy [in health IT] is still unclear to investors, and we don’t want to put a short fuse on a company trying to build a sustainable business,” says Dastmalchi.