This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.
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It can be frustrating for doctors and claims adjusters to know when a patient in a workers’ comp claim will heal from an injury, or how many rounds of physical therapy to prescribe them. Luckily, a new path is opening up on the horizon that promises to personalize medical records and predict accurate trends and outcomes using different points of data.
With injury mapping, doctors can assess where a patient is at, how their healing trajectory is coming along, and predict what will happen next. This new kind of interactive electronic medical record changes over time to reflect each person and their individual needs. Dr. John Alchemy talks in the following podcast about why this is so important, exciting, and much-needed in the workers’ compensation industry.
Injury map (noun) – a new kind of medical technology that is personalized for each patient that can point to how quickly they will recover and what their unique recovery trends are.
EMR (noun) – electronic medical records.
Matrix (noun) – an environment or material in which something develops; a surrounding medium or structure.
MMI (noun) – maximum medical improvement. It occurs when an injured employee reaches a state where his or her condition cannot be improved any further or when a treatment plateau in a person’s healing process is reached.
Claire Williams: Hello, and welcome to the California Workers’ Compensation Report. I am here today with Dr. John Alchemy to discuss injury mapping. Hi, John.
Dr. John Alchemy: Hi, Claire.
Claire Williams: So let’s start off. What is this category of injury mapping?
Dr. John Alchemy: Injury mapping is a new category, and it allows a stakeholder to take a look at the landscape for an individual, if you will, in a way that has not been available before. Basically what happens is a person gets injured, and their data goes into a system that can be an EMR, it can be a customized program, et cetera, but the injury mapping program will take a look at this dataset that’s unique to the patient, and start to put down markers and build a matrix of that individual. And as more information gets put on and the matrix sees the information move forward through time, the values and results in the matrix can now be weighted and interpolated and placed with trends and directions. And that’s really what we want. We want this category to be able to tell us something new and different that’s never been available before, and that’s basically how quickly is a person recovering, what are their trends once they’ve been given a treatment or an intervention, and when will they actually level off in their recovery and be considered permanent with regards to that particular injury? That is, in a nutshell, what injury mapping delivers.
Claire Williams: So this data, once its put in a matrix using injury mapping, it has real applications then for everybody in the workers’ compensation community. Let’s discuss some of those.
Dr. John Alchemy: Okay. So one of the big ones, and one of the big challenges, is: I’m a stakeholder that’s paying for service on an injured worker. And they just had six visits to physical therapy — very, very common situation — and the doctor, or the patient, or the insurance company is wondering “Hey, six visits seems to have helped them. Will another six help them?” Very, very common.
Claire Williams: Sure.
Dr. John Alchemy: And what injury mapping does is it takes a look at where this individual was before they did their first visit, their six visits of physical therapy, and where they are at the end of that. Now, six visits of physical therapy usually takes about two to three weeks to complete, so now we have two points in time, and injury maps will allow us to take a look at those trends and say “You know what? This person not only got better, but they recovered at a rate of X,” if you will. And if we define what the value of X is, as far as “Hey, this is a really favorable recovery,” “This is a slow recovery,” or “This really didn’t do anything at all,” once we have that information, the question kind of goes away, and it’s “Yeah, it worked,” or “No, it didn’t.” So it really works almost, if you will, as a return on investment for the stakeholders. Everyone wants to know, “Hey, we’re happy to put a resource out there,” and remember, this is a return on investment for the patient, too. They have to take time out of their schedule, they have to drive to the physical therapy appointment, they have to do that, they have to do their home exercises. Everybody’s making an investment here, and the big question that is often unanswered is A. Did it help? But B., more importantly, how much did it help? So that in and of itself is a huge benefit of this injury mapping category.
Claire Williams: So, not only is this taking patient’s data and creating injury maps, but they seem to me, from the way you’re describing it, to be also almost interactive as well as personalized maps.
Dr. John Alchemy: Yes. As I said before, they’re definitely personalized, because this is the individual’s information, no one else. And so we know how this particular person with this particular injury and/or their particular past medical history, maybe they had a prior injury before, all these things feed in to the favorability of a recovery. So when we do this, we’re not only, again, watching how, what direction they’re going, are they getting better, are they getting worse, but we’re finding out how fast is this happening, and then finally, we’re now able to make some estimates, if you will, on the trajectory of the recovery. Everybody wants to know two things in a work comp injury: 1. When are they gonna be better? And 2. How much is it going to cost us to get that recovery? Those are the two things, and that is why this category is so powerful, because it answers both of those questions.
Claire Williams: Right, whereas previously, those questions were only answered in hindsight, looking back on the injury. Is that correct?
Dr. John Alchemy: Absolutely. And I’ll tell you from being a physician doing work comp here now in California for 20 years, letter after letter after letter from the adjusters, from attorneys, from employers, and the patient sitting in front of me at the clinic, asking “When am I going to be done?” If you do not know that, you don’t know if they can go back to work, you don’t know what the benefits are going to be for the injury, you don’t know what their permanent functional limitations are, nothing can be answered until you know that particular question of “When is this injury going to be done?” or “When will the injury be recovered to maximum medical improvement? (MMI)” So once we have that, that is, if you will, the pot of gold at the end of the rainbow, the Holy Grail of workers’ compensation.
Claire Williams: Mhm.
Dr. John Alchemy: And until then, everyone just puts down a rough estimate, if the letters even ever get sent back to the insurance company. So if you’re an adjuster out there listening, you know how hard it is to get a doctor A. To commit on a piece of paper, and B. Get that back, and finally C., How accurate do you really think that estimate of MMI is?
Claire Williams: This seems like such an important use for data in workers’ compensation. And I’m curious, why is it that this category hasn’t been thought of? Why are we just seeing and hearing about it now? What are some of your thoughts on that?
Dr. John Alchemy: I think the biggest challenge in any type of market, work comp notwithstanding, is being able to standardize the knowledge and weigh it in a universal way that is both applicable and accurate.
Claire Williams: Mhm.
Dr. John Alchemy: And up until now, everyone has just used an EMR, if you will, as a new and different kind of pen and paper. But there hasn’t been any type of embedded logic in it, there hasn’t been any kind of standardized information that would objectify that data and give it value and direction. And the reason I think that it hasn’t been done, it’s a very complicated process. And we’ll just use workers’ comp as an example. Work comp has its own unique rules, its own unique rating system, it uses the AMA Guides Fifth Edition, which assigns particular values to particular injuries, all kinds of biologic metrics that it defines, and it’s very, very difficult to ask, not only one individual in workers’ comp provider to do that, but all of the workers’ comp providers to understand this information at this intimate level of detail and accuracy. It’s just not realistic. And so what we’re doing is we’re creating an environment now where anyone who’s doing workers’ compensation, and any type of stakeholder position, has very transparent and very objective information as to helping with the decision process. And that’s what this is about.
Claire Williams: Great. So where do we see this category going? How will it shape the future for the workers’ compensation story in California? And possibly for across the nation?
Dr. John Alchemy: Well, I want to go back to that map analogy, and I want people to think about this: When you’re gonna go on a trip, you look for a map. Whether that’s on a piece of paper, or on your car navigating system, or on your phone. And that map tells you a couple of things: One is it tells you where you are right now. It tells you your starting point. And that starting point in the workers’ comp injury could be the day you got hurt, it could be the day you transfer into a system that starts mapping your injury, and in some instances, it could actually be the day before you get hurt. Injury mapping has all kinds of applications. And imagine the situation where the employee goes in for a pre-injury physical, and they have a pre-existing condition. And that information can be captured and mapped before the individual even gets hurt. So in any situation, we have this map, and then what it does is it tell us “Okay, you’re here on the map, here is where you wanna go.” Alright? Then as you know, on any map, there are different paths, different roads you can take. And once you start mapping this information, you can say “Well, I wanna know how quickly I can get there.” But maybe I wanna know some other things, you know – “How often am I gonna need a follow-up visit?” “How long is it gonna take?” “What happens if a surgery gets thrown into the mix?” And all of the information in injury mapping can be reconfigured once that point and that new element of consideration is put into the mix. So it’s not only telling us where we start, it tells us where we wanna go, but it also tells us how to get there. And as you know on a navigation, that map is always gonna tell you “Hey, it’s gonna be this many miles, it’s gonna take you this many minutes, oh, and by the way, the freeway you wanna take has a back-up right now, here’s an alternative route.” And that is the parallel between injury mapping and helping us figure out where we are going and how quickly we can get there.
Claire Williams: Right. And not only do you want a map for any trip you’re going to take, but you especially want a map for somewhere you don’t necessarily want to be a very long time, such as stuck in a workers’ compensation case or injury.
Dr. John Alchemy: Absolutely. Everyone wants to know the map to get to those two final questions, like I said before. One, when will the case be at maximum medical improvement, really? And not guessing, but when will it be there, and what kind of data is that supported on? And then secondly, what are the costs of resources to get there? How much gas do I have to buy for my trip? How much physical therapy do I have to buy for this injured worker to actually give them meaningful benefit recovery? So there’s a lot of things that can be played off of this mapping type of concept. And I think we’re just now getting into the concept itself, and the infrastructure is going to continue to grow rapidly as the category develops.
Claire Williams: Certainly. Well, this is so exciting for workers’ compensation. Do you have any closing thoughts today? Perhaps we’ll have to have a second podcast on this category and what the implications are, but anything else for our listeners right now, John?
Dr. John Alchemy: I think the most important thing to take away from this podcast for anyone listening, is that there is a new category in place that’s now growing very rapidly, and that’s called injury mapping. Our product, our company, RateFast, is on the leading edge of defining that and actually putting it into real reports, making decisions for the stakeholders, and moving claims forward. So that’s the first thing I want people to think about. Injury mapping is not an EMR, it is not an off-the-shelf product yet, although it will be, I believe, in the foreseeable future. And it’s going to basically change the industry overnight once we start showing that this benefit and these decisions are no longer guesses, they’re simply based on data, but we had no way to organize or understand the data prior.
Claire Williams: Right. Great, well thanks so much, and it has been great talking about injury mapping today. We’ll look forward to joining our listeners next time.
Dr. John Alchemy: Absolutely, Claire. Thanks for having me.
Narrator: Thank you for joining us for this episode of the California Workers’ Comp Report. You can follow RateFast on Twitter at @ratefast, or visit www.rate-fast.com to learn more.