Author: hc1

October 6, 2022

Changes in seasons often accompany changes in diet, environment and behavior. Such changes can have a cascading effect on health, particularly for people who take prescription medication. Precision prescribing recognizes that every person has a unique combination of genetic, environmental and behavioral factors that will determine how specific medications will work for them.

The term pharmacokinetics describes how drugs move through the body—how they are absorbed, metabolized and eliminated. Pharmacodynamics describes how the drug affects the body. Food-drug interactions are how foods change a drug’s pharmacokinetics and pharmacodynamics. These changes can reduce the medication’s effectiveness or lead to adverse events. The impact of these changes can be difficult to predict because of the many factors involved: how much time elapses between eating and taking medication, the nutritional content of the food, and the amount of food eaten. Age, sex and genetics also affect how a person metabolizes food and medication. 

From Pumpkin Spice Lattes and Oktoberfest Märzens to Halloween candy and Thanksgiving  dishes,  favorite fall foods interact with drugs in different ways:

• Licorice. Before breaking into bags of black licorice this Halloween, you may want to check with your doctor, particularly if you are pregnant or older than 40. Commonly used in herbal remedies as well as candy, licorice contains glycyrrhizin, which can lower potassium. Licorice also can raise cortisol levels. These physiological effects mean that licorice doesn’t mix well with medications for high blood pressure or cardiovascular diseases, such as ACE inhibitors or diuretics. Combining such medication and licorice can lead to irregular heart rhythms.
• Grapefruit. Ruby Red grapefruit season starts in November, and this fruit’s sour kick can be just the ticket when your body needs a vitamin C boost. Yet grapefruit also blocks the CYP3A4 enzyme from metabolizing drugs in the small intestine, causing too much of the drug to be in your body. The affected drugs include some statins, some high blood pressure medication, some anti-anxiety drugs, and some corticosteroids. With some antihistamines, grapefruit prevents absorption of the drug, thus lowering the drug’s effectiveness. Grapefruit interactions are typically highlighted on a prescription’s warning label or the box containing over-the-counter medications.
• Cruciferous vegetables: Thanksgiving feasts have moved beyond green bean casserole to make room for roasted Brussels sprouts and mashed cauliflower, and rightly so. These vegetables from the Brassica botanical family are low in calories, high in fiber, and packed with nutrients, such as Vitamin K. What makes them different from other vegetables is that they contain glucosinolates, compounds that show promise in reducing cancer and cardiovascular disease risk and are the cause of their pungent odor and somewhat bitter taste. 

These typically beneficial qualities can work against specific medications, however. Warfarin is a blood thinner used to prevent blood clots; whereas, Vitamin K helps make blood clotting proteins. Drastically increasing your intake of, say, kale chips or green smoothies could interfere with warfarin’s effectiveness.  Cruciferous vegetables also increase the activity of the CYP1A2 enzyme, an enzyme involved in drug metabolism. As more drugs are developed that are metabolized via this enzyme, more research will be needed to determine how diets high in cruciferous vegetables might affect the effectiveness of those drugs. 

• Aged cheeses and meat. Charcuterie boards are not your friend if you take any of the class of drugs known as monoamine oxidase inhibitors (MAOI). MAOIs are prescribed to treat depression and Parkinson’s disease. As the name suggests, they block monoamine oxidase, an enzyme that breaks down tyramine. Our bodies use tyramine to control blood pressure, and foods such as cheddar cheese, salami and pickles are full of it. If you are taking medication that prevents tyramine from being broken down while ingesting more tyramine, you are likely to end up with too much tyramine, and too much tyramine can cause dangerous blood pressure spikes.

• Beer, wine and liquor. Alcohol is a drug that depresses the central nervous system and can damage the liver. These effects can be increased to dangerous levels when alcohol is combined with medications that have similar effects, such as sedatives and pain relievers. For example, you may become extremely drowsy if you drink alcohol while taking medication to deal with autumn ragweed allergies. Another bad combination is alcohol and acetaminophen, which are both metabolized by the CYP2E1 enzyme and together can lead to liver toxicity.
• Coffee. As the weather gets chillier and the days get shorter, you might pour yourself multiple mugs of coffee to stay warm and awake. Coffee contains caffeine, a stimulant, which gives coffee its bitter taste and has many different pharmacokinetic interactions with prescription drugs. Coffee interferes with drug absorption by changing stomach acid levels, for example, and interferes with drug excretion by increasing urine volume. 

Food-drug interactions are one of many patient data points providers have to take into account to create effective treatment plans. Patients will try to make themselves feel better before they ever set foot in a doctor’s office, so patient encounters should include questions about over-the-counter medications, herbal supplements, and diet changes in addition to medical history and current symptoms.

To learn how hc1 can help your healthcare organization ensure that patients get the right tests and the right prescriptions no matter the season,  request a demo!

September 8, 2022

When you go to a doctor or a hospital, the reason for your visit (known as an encounter in medical terms) is assigned an ICD code. ICD stands for International Classification of Diseases, which is the worldwide standard for recording healthcare information about human morbidity (disease) and mortality (death). The World Health Organization (WHO) explains the importance of ICD as a common language for recording, reporting and monitoring diseases, allowing the world to compare and share data in a consistent and standard way—between hospitals, regions and countries and over periods of time. The diagnostic information in ICD codes supports data for use throughout healthcare, such as public health records, patient safety and high-value care initiatives, medical device and pharmaceutical development and insurance reimbursements.

Since 1946, WHO has managed the revisions of the ICD. The latest version, ICD-11, went into effect this year. According to the ICD-11 Fact Sheet, “ICD–11 is a vast improvement on previous revisions.” The new coding system is expected to improve ease and accuracy of coding and require less user training.  ICD–11 is also ready for use in multiple IT environments with a new API. By transitioning to ICD-11, healthcare organizations will open up numerous possibilities to improve research and patient care.

The BMC Medical Informatics and Decision Making journal article, “ICD-11: an international classification of diseases for the twenty-first century,” highlights these major changes in ICD-11:

• The Foundation database: This database expands how diseases and causes of death can be described and classified. It includes support for multiple languages and details about stages or severity of disease and includes elements to track disease genomics, causes and manifestations as they are discovered. This database also allows for multiple parent and child relationships within the ICD framework to better reflect the complexity of certain diseases. For example, stroke is now in both the neurological and cardiovascular categories (called chapters in the ICD)  instead of just being in the cardiovascular category, as in ICD-10.

• Stem codes, extension codes and unique identifiers: ICD-11 includes both stem codes for the main diagnosis and extension codes for related information, such as medication, injury location or disease cause. These codes can be clustered to provide a more detailed record of a patient’s disease. Each concept in ICD-11 also has a unique identifier. These codes and identifiers, along with the APIs the WHO has developed, make it possible for software developers to access and use the ICD coding structure.

• New chapters: ICD-11 has chapters for sleep-wake disorders and sexual health in response to an increased focus on these medical topics since the release of ICD-10. Blood diseases and immune system diseases are now in separate chapters to reflect the differences in the causes and treatment of these diseases. A chapter for traditional medicine concepts enables medical coders to record disease information gathered from a variety of medical environments.

U.S. healthcare organizations currently use a version of ICD-10, ICD-10 CM (Clinical Modification), to classify disease data. The National Center for Health Statistics developed the ICD-10 CM and updates it annually. For example, modifications in the last few years include new codes for vaping-related disorder, COVID-19 and post-COVID-19 condition. Spend any time with the ICD-10-CM Browser Tool and you will appreciate how detailed and complex the ICD can be and why medical coders require specialized training to learn how to apply these codes correctly. Also, you might be left wondering how often the  Y93.C1 (Activity, Computer keyboarding) code is used as the cause for an injury.

The U.S. transition to ICD-11 will take several years, although hopefully nowhere near as long as it took  to fully transition to ICD-10. After many delays, the ICD-10 was fully implemented in the United States in 2015, 25 years after it was endorsed by the WHO. The National Committee on Vital and Health Statistics, which advises the Secretary of Health and Human Services on these matters, has recommended that the HHS conduct research on how to best implement ICD-11 in the U.S. healthcare system and regularly communicate the status of that research to healthcare organizations to help prevent undue ICD-11 transition costs. In its letter, “Updated Recommendations for Immediate Action on ICD-11,” the committee states, “The need for research is compelling given ICD-11 may, or may not, provide significant opportunity to reduce provider burden and increase interoperability of electronic health information – high priority goals for the U.S.”

At hc1, the hc1 Lab Insights Platform™ ingests ICD codes from an interface with a client’s electronic health record or laboratory information system and stores them in diagnosis records within that client’s hc1 environment. These records can inform insights within different solutions. For example, a client can use these codes to set diagnosis criteria for laboratory test ordering guidelines in hc1 PrecisionDx Advisor.  When the U.S. healthcare system fully adopts ICD-11, hc1 will be ready to ingest the expanded data and develop innovative healthcare solutions based on this rich framework.

To learn more about how hc1 can help unlock insights from diagnosis and other patient encounter data, click here to request a personalized demo! 

August 19, 2022

A male family member of mine recently underwent a heart catheterization procedure at a reputable hospital. The surgeon, a well-regarded specialist in the field, inserted two stents to reverse 95% and 80% blockages in two respective arteries. Post-procedure he was cleared to return home. Though feeling completely better varies between each patient, he wasn’t feeling any better after a week, two weeks or a month post-procedure. This began a journey through the labyrinth of miscommunication between health systems, between providers and health system departments, between providers and ultimately between provider and patient.

Sadly, this isn’t an uncommon scenario. Health systems have been struggling to achieve better access to data and enhanced communication between departments, providers and patients for many years, and the problem is increasing. According to an article published by Fierce Healthcare, only 4 in 10 health systems can successfully share data with other health systems. With the number of health service options available to individuals in the United States, one can receive basic health care services at a local CVS, Walgreens, Meijer, local med centers and preferred providers and community hospitals. But what about the patient’s records? Information about what a person has been treated for and medications prescribed? It’s all scattered in various locations that don’t always connect or communicate with one another, ending up as holes in a patient profile for overall assessment.

As a month turned into six weeks and more, our loved one continued to have shortness of breath and exhaustion. Blood tests, EKGs, CT and MRI were all done, and no information was shared with him from his provider. We had to call and chase down answers and results being shifted from one department to another because records were not easily accessible between locations. Ultimately, we were left to seek additional care from a new health system and heart specialist.

The new provider requested the notes and images from his recent heart catheterization procedure and follow-ups. After contacting the original provider, we were assured that those documents, records and images would be sent to the new provider via a digital portal available for providers to send patient information to one another. After a fruitless period of three weeks and several calls from the new provider, as well as ourselves, to the original health system to find out why the patient records had not been received after we had been told they had been sent, the new provider was left with no option but to conduct a second round of tests, CT scan, MRI and another heart catheterization procedure.

When the surgeon came to consult after the second heart cath, I asked why his office never received records and images from the first health system. The new surgeon expressed frustration over the constant struggle in the sharing of patient information between health systems and even within their health system. Without solicitation, the surgeon went on to say that he and other providers face this daily in their work and that it is an ultimate detriment to patients.

So, what’s stalling health system data-sharing? A recent article by Becker’s Hospital Review posed the same question in a thorough Q&A format with the CIO of University of Utah Health, Donna Roach. She said interoperability is the key. 

Patient data is already being captured and stored; it’s sitting and waiting to be unlocked and shared to provide highly beneficial information that can save lives and initiate a higher level of patient care. The data is also valuable from a cost perspective. When providers lack full access to patient data, tests may be unnecessarily repeated, resulting in excessive costs to health systems, patients and payers.

The information is housed in data hubs stored within health systems and should be easily accessible. In many healthcare organizations and clinical labs, patients, providers and staff wait for the trickle-down of information and results as the data is untangled from the system. This situation costs valuable time and causes duress to patients waiting to know the next steps in their care. Healthcare shouldn’t be a burden to the patient. Patients shouldn’t have to be the ones to chase information down because health system departments don’t have access to the right tools to communicate with one another. 

Our loved one is now doing well. The follow-up care he receives after the second procedure is beneficial in regaining his overall wellness. 

I’m proud that hc1 is working to help health systems and labs achieve better workflows, improve communications between departments, and unlock patient data, enabling better quality healthcare for all. You can learn more about what we are working toward at www.hc1.com/platform

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Lorri Markum is the marketing manager for hc1 Insights and has over two decades of corporate and nonprofit marketing leadership experience. Lorri specializes in B2B marketing and is SEO Certified. A graduate of Ball State University with a degree in psychology, digital communications and storytelling. For the past 25 years, Lorri has been a professional commercial photographer and photojournalist in the music industry. Before joining hc1 she served as the marketing manager for a nonprofit healthcare organization, serving 40 counties throughout Indiana.