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Bridging the Communication Gap Between Health Plans and Providers

Posted on October 3, 2018 I Written By

The following is a guest blog post by Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Effective communication and trust are the essential keys to any relationship, and the plan-provider relationship is no different. A shift towards value-based coordinated accountable care has urged health plans and providers to collaborate to improve population health and patient experience while lowering costs. Most plan-provider communication revolves around rate negotiations.

An open, honest relationship with transparent communication and cooperation is needed to bridge the communication gap and create mutually beneficial partnerships. Sharing data, creating health plan-provider networks, utilizing audits and providing access to new technologies are all methods health plans and providers could use to help promote collaboration and bridge communication.

Data Sharing Across the Care Continuum

To foster collaboration, data sharing should be implemented and incentives should be aligned across the care continuum so that both parties are motivated to improve outcomes and lower costs. Data sharing is one of the key benefits of bridging the communication gap between health plans and providers.

Health plans hold the bulk of useful data and, when that data is combined with the providers’ clinical expertise, the likely result is better patient outcomes. Sharing data gives providers access to claims information that also provides with them a patient’s entire medical history. This information is useful in helping educate patients about their health risks and to boost transparency in plan-provider communication.

Health plans and providers keep a vast amount of patient information. Health plans have historical claims data while providers have clinical data. Both parties use their data for checks and balances and to mutually determine the best treatment and most appropriate care for patients. Lack of collaboration, usually due to interoperability challenges, means both data types aren’t shared. A key aspect to achieving collaboration and alignment is trust. Sometimes parties are lacking in trust when it comes to the use of their data; however, advancements in technology and use of the blockchain to create transparency are helping to change the tides.

Health plans and providers must have upfront discussions on what information will be shared, and each party must share data that is useful to the other. For health plans, this means understanding how reimbursement is determined, the factors that influence the payments they receive and how they are reimbursed based on clinical outcomes rather than interventions delivered. In turn, providers must clearly communicate the clinical outcomes health plans are or are not achieving. Ultimately, all measures should include preventative care, lower per capita cost and improve population health as well as patient experience and satisfaction. They should also improve how data is managed and transitioned. Providers that implement a strategic quality management approach to deliver high-quality, valued-based care can achieve better clinical outcomes.

Health Plan-provider Networks

Plan-provider communication networks are needed to efficiently and effectively harness data from both parties and enable rapid innovation and the sharing of real-time data for immediate response. Health plan-provider networks utilize care management, electronic health records (EHRs), and analytics to seek to resolve communication and collaboration challenges between health plans and providers. In keeping with HIPAA regulations, communication between health plans and providers must be customized to include only information that is relevant to specific attributed patient populations, physicians, reimbursement and care delivery models. The goal of plan-provider networks is to present both parties with transparent, high-quality data to improve trust and increase health plan-provider engagement to improve communication and, ultimately, population health.

Using Audits to Bridge Communication

The rise of audit requests has posed a problem in the plan-provider relationship. Both health plans and providers must work toward greater compliance, and auditing medical records is a crucial step in the process.

Providers struggle with numerous types of information requests from various third-party health plans, governmental agencies and national health plans, which often have different deadlines and vernaculars. As a result, health plans are forced to repeatedly call health information management (HIM) and audit departments when claims data inaccurately identifies place of service, provider or other patient information. An upsurge in audit requests from commercial and other health plans threatens to exacerbate these problems.

The audit process can change the plan-provider relationship from adversarial to advantageous by improving communication. Bridging communication gaps and language barriers through clearer record requests would take the burden off providers and alleviate plan problems. Technology will also play a critical role in making this entire process as automated as possible.

Chart requests that come from commercial health plan audits represent just five percent of all requests that providers receive. Hospitals also receive high volumes of medical record requests from other hospitals, physicians, attorneys, patients and more. The problem is that commercial plans often assume they are the only requestor. Education is required on both sides of the audit equation to improve processes and reduce plan-provider friction.

For providers, all data from each request and submission should be entered in a centralized audit management software application for the organization. This helps providers track audit activity by health plan and type of audit, maintain a record of all documents sent, better manage requests, and stay abreast of audit trends.

Patient access, clinical coders, billers and collectors perform unique functions and speak different languages across the hospital revenue cycle. Similarly, commercial health plans have multiple departments and terminology involved in audit processing. In many cases, inter-departmental communication and language barriers are the main obstacles to overcome.  However, technology is playing a growing role in creating greater transparency within the healthcare ecosystem—by acquiring, digitizing and giving shape to both structured and unstructured records.

Time Will Tell

Bridging the communication gap will not happen overnight. It will take time and effort from all parties involved; however, these methods are a good starting point.

As the digital era has taken hold, our attentions are turning to a better utilization of the vast data flowing through both providers and health plans. This will translate into a better understanding of patient outcomes, improved revenue cycles and more insightful growth strategies for all parties.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

Important Patient Data Questions Hospitals Need To Address

Posted on July 13, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Obviously, managing and protecting patients’ personal health information is very important already.  But with high-profile incidents highlighting questionable uses of consumer data — such as the recent Facebook scandal – patients are more aware of data privacy issues than they had been in the past, says Dr. Oleg Bess, founder and CEO of clinical data exchange company 4medica.

According to Bess, hospitals should prepare to answer four key questions about personal health information that patients, the media and regulators are likely to ask. They include:

  • Who owns the patient’s medical records? While providers and EHR vendors may contend that they own patient data, it actually belongs to the patient, Bess says. What’s more, hospitals need to be sure patients should have a clear idea of what data hospitals have about them. They should also be able to access their health data regardless of where it is stored.
  • What if the patient wants his or her data deleted? Unfortunately, deleting patient data may not be possible in many cases due to legal constraints. For example, CMS demands that Medicare providers retain records for a fixed period, and many states have patient record retention laws as well, Bess notes. However, if nothing else, patients should have the ability to decline having their personally-identifiable data shared with third parties other than providers and payers, he writes.
  • Who is responsible for data integrity? Right now, problems with patient data accuracy are common. For example, particularly when patient matching tools like an enterprise master patient index aren’t in place, health data can end up being mangled. To this point, Bess cites a Black Book Research survey concluding that when records are transmitted between hospitals that don’t use these tools, they had just a 24% match rate. Hospital data stewards need to get on top of this problem, he says.
  • Without a national patient ID in place, how should hospitals verify patient identities? In addition to existing issues regarding patient safety, emerging problems such as the growing opioid abuse epidemic would be better handled with a unique patient identifier, Bess contends. According to Bess, while the federal government may not develop unique patient IDs, commercially developed master patient index technology might offer a solution.

To better address patient matching issues, Bess recommends including historical data which goes back decades in the mix if possible. A master patient index solution should also offer enterprise scalability and real-time matching, he says.

AMIA17 – There’s Gold in Them EHRs!

Posted on November 13, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

If even 10% of the research presented at the 2017 American Medical Informatics Association conference (AMIA17) is adopted by mainstream healthcare, the impact on costs, quality and patient outcomes will be astounding. Real-time analysis of EHR data to determine the unique risk profile of each patient, customized remote monitoring based on patient + disease profiles, electronic progress notes using voice recognition and secondary uses of patient electronic records were all discussed at AMIA17.

Attending AMIA17 was an experience like no other. I understood less than half of the information being presented and I loved it. It felt like I was back in university – which is the only other time I have been around so many people with advanced degrees. By the time I left AMIA17, I found myself wishing I had paid more attention during my STATS302 classes.

It was especially interesting to be at AMIA17 right after attending the 3-day CHIME17 event for Hospital CIOs. CHIME17 was all about optimizing investments made in HealthIT over the past several years, especially EHRs (see this post for more details). AMIA17 was very much an expansion on the CHIME17 theme. AMIA17 was all about leveraging and getting value from the data collected by HealthIT systems over the past several years.

A prime example of this was the work presented by Michael Rothman, Ph.D of Pera Health. Rothman created a way to analyze key vital signs RELATIVE to a patient’s unique starting condition to determine whether they are in danger. Dubbed the Rothman Index, this algorithm presents clinicians and caregivers with more accurate alarms and notifications. With all the devices and systems in hospitals today, alarm fatigue is a very real and potentially deadly situation.

Missed ventilator alarms was #3 on ECRI Institute’s 2017 Top 10 Health Technology Hazards. It was #2 on the 2016 Top 10 list. According to ECRI: “Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death”. The challenge is not the response but rather how to determine which alarms are informational and which are truly an indicator of a clinical condition that needs attention.

Comments from RNs in adverse-event reports shared in a 2016 presentation to the Association for the Advancement of Medical Instrumentation (AAMI) sums up this challenge nicely:

“Alarm fatigue is leading to significant incidents because there are so many nuisance alarms and no one even looks up when a high-priority alarm sounds. Failure to rescue should be a never event but it isn’t.”

“Too many nuisance alarms, too many patients inappropriately monitored. Continuous pulse oximetry is way overused and accounts for most of the alarms. Having everyone’s phone ring to one patient’s alarm makes you not respond to them most of the time.”

This is exactly what Rothman is trying to address with his work. Instead of using a traditional absolute-value approach to setting alarms – which are based on the mythical “average patient” – Rothman’s method uses the patient’s actual data to determine their unique baseline and sets alarms relative to that. According to Rothman, this could eliminate as much as 80% of the unnecessary alarms in hospitals.

Other notable presentations at AMIA17 included:

  • MedStartr Pitch IT winner, FHIR HIEDrant, on how to mine and aggregate clinically relevant data from HIEs and present it to clinicians within their EHRs
  • FHIR guru Joshua C Mandel’s presentation on the latest news regarding CDS Hooks and the amazing Sync-for-Science EHR data sharing for research initiative
  • Tianxi Cai of Harvard School of Public Health sharing her research on how EHR data can be used to determine the efficacy of treatments on an individual patient
  • Eric Dishman’s keynote about the open and collaborative approach to research he is championing within the NIH
  • Carol Friedman’s pioneering work in Natural Language Processing (NLP). Not only did she overcome being a woman scientist but also applying NLP to healthcare something her contemporaries viewed as a complete waste of time

The most impressive thing about AMIA17? The number of students attending the event – from high schoolers to undergraduates to PhD candidates. There were hundreds of them at the event. It was very encouraging to see so many young bright minds using their big brains to improve healthcare.

I left AMIA17 excited about the future of HealthIT.

Is There a Case to Be Made that Interoperability Saves Hospitals Money?

Posted on April 17, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Back in 2013 I argued that we needed a lot less talk and a lot more action when it came to interoperability in healthcare. It seemed very clear to me then and even now that sharing health data was the right thing to do for the patient. I have yet to meet someone who thinks that sharing a person’s health data with their providers is not the right thing to do for the patient. No doubt we shouldn’t be reckless with how we share the data, but patient care would improve if we shared data more than we do today.

While the case for sharing health data seems clear from the patient perspective, there were obvious business reasons why many organizations didn’t want to share their patients health data. From a business perspective it was often seen as an expense that they’d incur which could actually make them lose money.

These two perspectives is what makes healthcare interoperability so challenging. We all know it’s the right thing to do, but there are business reasons why it doesn’t make sense to invest in it.

While I understand both sides of the argument, I wondered if we could make the financial case for why a hospital or healthcare organization should invest in interoperability.

The easy argument is that value based care is going to require you to share data to be successful. That previous repeat X-ray that was seen as a great revenue source will become a cost center in a value based reimbursement world. At least that’s the idea and healthcare organizations should prepare for this. That’s all well and could, but the value based reimbursement stats show that we’re not there yet.

What are the other cases we can make for interoperability actually saving hospitals money?

I recently saw a stat that 70% of accidental deaths and injuries in hospitals are caused by communication issues. Accidental deaths and injuries are very expensive to a hospital. How many lives could be saved, hospital readmissions avoided, or accidental injuries could be prevented if providers had the right health data at the right place and the right time?

My guess is that not having the right healthcare data to treat a patient correctly is a big problem that causes a lot of patients to suffer needlessly. I wonder how many malpractice lawsuits could be avoided if the providers had the patients full health record available to them. Should malpractice insurance companies start offering healthcare organizations a doctors a discount if they have high quality interoperability solutions in their organization?

Obviously, I’m just exploring this idea. I’d love to hear your thoughts on it. Can interoperability solutions help a hospital save money? Are their financial reasons why interoperability should be implemented now?

While I still think we should make health data interoperability a reality because it’s the right thing to do for the patients, it seems like we need to dive deeper into the financial reasons why we should be sharing patient’s health data. Otherwise, we’ll likely never see the needle move when it comes to health data sharing.

National Health Service Hospitals Use Data Integration Apps

Posted on February 20, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While many providers in the US are still struggling with selecting and deploying apps, the UK National Health Service trusts are ready to use them to collect vital data.

According to the New Scientist, the four National Health Services serving the United Kingdom are rolling out two apps which help patients monitor their health at home. Both of the apps, which are being tested at four hospitals in Oxfordshire, UK, focus on management of a disease state.

One, called GDm-health, helps manage the treatment of gestational diabetes, which affects one in 10 pregnant women. Women use the app to send each of their blood glucose readings to the clinician monitoring their diabetes. The Oxford University Institute of Biomedical Engineering led development of the app, which has allowed patients to avoid needless in-person visits. In fact, the number of patient visits has dropped by 25%, the article notes.

The other app, which was also developed by the Institute, helps patients manage chronic obstructive pulmonary disease, which affects between 1 million and 1.5 million UK patients. COPD patients check their heart rate and blood oxygen saturation every day, entering each result into the app.

After collecting three months of measurements, the app “learns” to recognize what a normal oxygen sat level is for that patient. Because it has data on what is normal for that patient, it will neither alert clinicians too often nor ignore potential problems. During initial use the app, which already been through a 12-month clinical trial, cut hospital admissions among this population by 17% and general practitioner visits by 40%.

NHS leaders are also preparing to launch a third app soon. The technology, which is known as SEND, is an iPad app designed to collect information on hospital patients. As they make their rounds, nurses will use the app to input data on patients’ vital signs. The system then automatically produces an early warning score for each patient, and provides an alert if the patient’s health may be deteriorating.

One might think that because UK healthcare is delivered by centralized Trusts, providers there don’t face data-sharing problems in integrating data from apps like these. But apparently, we would be wrong. According to Rury Holman of the Oxford Biomedical Research Centre, who spoke with New Scientist, few apps are designed to work with NHS’ existing IT systems.

“It’s a bit like the Wild West out there with lots of keen and very motivated people producing these apps,” he told the publication. “What we need are consistent standards and an interface with electronic patient records, particularly with the NHS, so that information, with permission from the patients, can be put to use centrally.”

In other words, even in a system providing government-delivered, ostensibly integrated healthcare, it’s still hard to manage data sharing effectively. Guess we shouldn’t feel too bad about the issues we face here in the US.

Health System Sees Big Dividends From Sharing Data

Posted on November 21, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For some health organizations, the biggest obstacle to data sharing isn’t technical. Many a health IT pundit has argued — I think convincingly — that while health organizations understand the benefits of data sharing, they still see it as against their financial interests, as patients with access to data everywhere aren’t bound to them.

But recently, I read an intriguing story by Healthcare IT News about a major exception to the rule. The story laid out how one healthcare system has been sharing its data with community researchers in an effort to promote innovation. According to writer Mike Miliard, the project was able to proceed because the institution was able to first eliminate many data silos, giving it a disciplined view of the data it shared.

At Sioux Falls, South Dakota-based Sanford Health, one health leader has departed from standard health system practices and shared a substantial amount of proprietary data with research organizations in his community, including certain clinical, claims, financial and operational data. Sanford is working with researchers at South Dakota State University on mathematics issues, University of South Dakota business researchers, Dakota State University on computer science/informatics and University of North Dakota on public health.

The effort is led by Benson Hsu, MD, vice president of enterprise data and analytics for the system. Hsu tells the magazine that the researchers have been developing analytical apps which are helping the health system with key issues like cost efficiencies, patient engagement and quality improvement. And more radically, Hsu plans to share what he discovers with competitors in the community.

Hsu laid the groundwork for the program, HIN reports, by integrating far-flung data across the sprawling health system, including multiple custom versions of the Epic EHR, multiple financial accounts and a variety of HR systems; analytics silos cutting across areas from clinical decision support and IT reports to HR/health plan analytics; and data barriers which included a lack of common data terms, benchmarking tools and common analytic calculator. But after spending a year pulling these areas into a functioning analytics foundation, Sanford was ready to share data with outside entities.

At first, Hsu’s managers weren’t fond of the idea of sharing masses of clinical data with anyone, but he sold them on the idea. “It’s the right thing to do. More importantly, it’s the right thing to do for the community — and the community is going to recognize that Sanford health is here for the community,” he argued. “Secondly, it’s innovation. Innovation in our backyard, based on our population, our social determinants, our disparities.”

According to HIN, this “crowdsourced” approach to analytics has helped Sanford make progress with predicting risk, chronic disease management, diagnostic testing and technology utilization, among other things. And there’s no reason to think that the effort won’t keep generating progress.

Many institutions would have shot down an effort like this immediately, before it could accomplish results. But it seems that Sanford’s creative approach to big data and analytics is paying off. While it might not work everywhere, I’m betting there are many other institutions that could benefit from tapping the intellect of researchers in their community. After all, no matter how smart people are, some answers always lie outside your walls.

Data Sharing Largely Isn’t Informing Hospital Clinical Decisions

Posted on July 6, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Some new data released by ONC suggests that while healthcare data is being shared far more frequently between hospitals than in the past, few hospital clinicians use such data regularly as part of providing patient care.

The ONC report, which is based on a supplement to the 2015 edition of an annual survey by the American Hospital Association, concluded that 96% of hospitals had an EHR in place which was federally tested and certified for the Meaningful Use program. That’s an enormous leap from 2009, the year federal economic stimulus law creating the program was signed, when only 12.2% of hospitals had even a basic EHR in place.

Also, hospitals have improved dramatically in their ability to share data with other facilities outside their system, according to an AHA article from February. While just 22% of hospitals shared data with peer facilities in 2011, that number had shot up to 57% in 2014. Also, the share of hospitals exchanging data with ambulatory care providers outside the system climbed from 37% to 60% during the same period.

On the other hand, hospitals are not meeting federal goals for data use, particularly the use of data not created within their institution. While 82% of hospitals shared lab results, radiology reports, clinical care summaries or medication lists with hospitals or ambulatory care centers outside of their orbit — up from 45% in 2009 — the date isn’t having as much of an impact as it could.

Only 18% of those surveyed by the AHA said that hospital clinicians often used patient information gathered electronically from outside sources. Another 35% reported that clinicians used such information “sometimes,” 20% used it “rarely” and 16% “never” used such data. (The remaining 11% said that they didn’t know how such data was used.)

So what’s holding hospital clinicians back? More than half of AHA respondents (53%) said that the biggest barrier to using interoperable data integrating that data into physician routines. They noted that since shared information usually wasn’t available to clinicians in their EHRs, they had to go out of the regular workflows to review the data.

Another major barrier, cited by 45% of survey respondents, was difficulty integrating exchange information into their EHR. According to the AHA survey, only 4 in 10 hospitals had the ability to integrate data into their EHRs without manual data entry.

Other problems with clinician use of shared data concluded that information was not always available when needed (40%), that it wasn’t presented in a useful format (29%) and that clinicians did not trust the accuracy of the information (11%). Also, 31% of survey respondents said that many recipients of care summaries felt that the data itself was not useful, up from 26% in 2014.

What’s more, some technical problems in sharing data between EHRs seem to have gotten slightly worse between the 2014 and 2015 surveys. For example, 24% of respondents the 2014 survey said that matching or identifying patients was a concern in data exchange. That number jumped to 33% in the 2015 results.

By the way, you might want to check out this related chart, which suggests that paper-based data exchange remains wildly popular. Given the challenges that still exist in sharing such data digitally, I guess we shouldn’t be surprised.

Patients Deserve Complete Access To Their Health Data

Posted on February 23, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As a vigorous healthcare advocate — for both myself and ailing family members and friends — I love the idea of OpenNotes. As some readers will know, the OpenNotes model gives patients easy access to their clinician’s visit notes within the system’s EMR.

As you can see below, the idea has gone from a three-practice demo to a hot idea:

Chart courtesy of OpenNotes,org

Still, given the widespread adoption of EMRs by hospitals, you’d think the list of participating healthcare organizations would be longer.  The group represents a very small percentage of U.S. hospitals and clinics.

I’ve read many critical analyses of the OpenNotes concept, and some have a reasonable foundation. But if you dig into the analyses, it becomes pretty clear what’s going on; critics believe that doctors and patients are insecure and immature.

After all, while there might be some exceptions to the rule — such as providing too much access to mentally ill patients during an acute episode —  in general I believe that patients should have complete access to information concerning their health status and treatment.

After all, whenever possible medical treatment should be based on consensus, especially when clinician and patient don’t know each other well. No EMR on the planet can teach the doctor about my history as quickly and accurately as I can. OK, I admit it, I didn’t go to medical school, but as a 50-year old patient activist with multiple chronic illnesses spanning 30 years, I would tend to believe that I understand me better than an ED doc that met me five minutes ago.

Not only that, I’d argue that if the information a clinician creates concerns my health, well-being and safety, it’s flat unethical to keep me from seeing it. I want to know what’s going on and I want to know now. But many institutional practices make even routine data sharing difficult. I’ve even had medical practices refuse to share clinical testing results via their portal until the clinician had “approved” it. Yeah — try saying that to my face, lady.

Bottom line, both sides should be capable of addressing documented reality and debating matters of opinion like adults. Assuming otherwise might protect clinician and patients from bruised feelings, but it doesn’t improve their care. Instead, it keeps an obstacle to collaborative medicine in place which shouldn’t be there.