Interoperability is the base layer. Then, how do we use data to coordinate human behavior? We make it easier for them by meeting them in their workflow, not making them go look up information. They can understand which of their patients are at a place of need and coordinate with others who can help meet the needs of that individual, to lift them up and catch them before they fall.
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“Event notification systems and care coordination applications have historically struggled to provide actionable information to providers at the point-of-care,” Noah Knauf, partner at Kleiner Perkins, said in a statement. “Collective Medical is the first technology we’ve seen that allows the providers and payers in a local healthcare system to efficiently collaborate, delivering significantly better outcomes through risk analytics, real-time notifications, and shared care planning tools. Supporting this team is a rare opportunity to be a part of something that is meaningfully changing the way care is delivered in this country.”
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Collective Medical addresses those challenges by mining data universally available in all EHRs and filtering those data, displaying directly within a clinician’s workflow only what is relevant to a particular care decision. Furthermore, Collective immediately alerts a patient’s entire care team when an event, such as an ER admission, occurs, thereby accelerating care coordination.
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Beyond just offering a good meal, these events create community, says chef and co-owner Joseph Nelson. Diners share a family-style meal at one long table and inevitably find themselves making connections, he says. “It’s a bunch of people who have never met each other before, sitting down for a couple of hours,” Nelson says. “By the end of dinner, you’d think they’d known each other for years.”
If you’re looking to make the leap from cannabis consumer to pot producer, Home Grown Academy in Carver can help. Owners Jason Cullinan and Paul Brennan offer classes for all levels, from the aspiring cultivator to the experienced producer. Learn the fundamentals in Intro to Growing Cannabis or discover how to tackle a bigger project with Grow Room Design & Construction. The four-hour classes cost $150; a series of five goes for $500.
The fast-growing pot industry not only raked in $2.7 billion in sales this last year, it’s also produced quite a few ganja-based startups. It’s legal to light up a bowl for recreation or medical reasons in 23 of these 50 United States now and soon as there’s a growing industry, there are technological innovations to support it. We’ve counted at least 8 on-demand delivery apps out there that will bring medicinal grade weed varietals right to your door.

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One day in March 2012, two hospitals emailed him requesting the software. “I remember thinking ‘this is odd,’” says Green. Then, a nurse from Olympia, Washington called. “How do you guys like being mandated?” she asked. Unbeknownst to them, doctors had proposed Collective Medical to the state to curtail ER visits. Says van den Akker: “If you want providers to be advocates of your software, it takes time and effort. Anyone trying to sell a quick solution to something is in for a lot of pain.”
They found Collective Medical Technologies, a little company from Salt Lake City, Utah, belonging to Adam Green and Wylie van den Akker, childhood friends from Boise, Idaho. Between school and daytime jobs, they had managed to sell their software to 35% of hospitals in Washington. Emergency doctors raved about it and pushed for its adoption. The governor gave the go-ahead, but all 98 hospitals in the state had to comply. To be effective, they had to share patient information. “The value of the network is in participants,” says Chris Klomp, CEO of Collective Medical, and a childhood friend of the founders.
The effort to create the first pathway began with the IT staff writing structured query language (SQL) code to extract the necessary data from the hospital’s Allscripts EHR, enterprise data warehouse, surgical, financial and corporate performance systems. This data was brought into the clinical variation management application using the FHIR (Fast Healthcare Interoperability Resources) standard.
Our goal now is to invest in the platform and to grow networks. Building network effect-enabled platforms is capital intensive because you need to reach critical density in a given geography to create value for the constituents there. We’ve done a pretty good job of that. We’re live in 17 states, not just with one or two hospitals, but penetrated broadly to 100 percent of acute hospitals. We’ve got a bunch more in the hopper.
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Might next year prove to be different? Yes, absolutely, especially given the coming mandates coming out of the Protecting Access to Medicare Act (PAMA), which will require referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services—CT, MR, nuclear medicine and PET—for Medicare patients. The federal Centers for Medicare and Medicaid Services (CMS) will progress with a phased rollout of the CDS mandate, as the American College of Radiology (ACR) explains on its website, with voluntary reporting of the use of AUC taking place until December 2019, and mandatory reporting beginning in January 2020.

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The optimal events, sequence, and timing of care were presented to the physician team using an intuitive interface that allowed them to understand exactly why each step, and the timing of the action, was recommended. Upon approval, the team operationalized the new care path by revising the emergency-department and inpatient order sets in the hospital EHR.
The company has an intriguing startup story. Fifteen years ago, one of the founders’ mother, Patti Green, was an emergency department social worker in Boise, Idaho, and suspected that some patients were opioid seekers. She set up a rudimentary collaborative care plan for providers to use to identify and help these patients. “It is easy for us now to talk about the opioid epidemic. Nobody was really talking about it 15 years ago, but she was seeing it on the ground,” says Chris Klomp, Collective’s CEO, “and she did something about it.”
Feeling achy? Hit the massage table. At E-motion Sports Massage in Everett, clients can loosen up with a cannabis-infused ointment that many say boosts the impact of the treatment. Massage therapists use a cream infused with cannabinoids, compounds derived from the cannabis plant. They don’t cause a high, but they do have powerful anti-inflammatory and pain-killing effects, says E-motion owner Mercedes Diaz. And because the cream reduces pain, she says, therapists can work muscles more intensively — and effectively. “It is really great for muscle and joint pain, arthritis, sprains, strains,” Diaz says. “With cannabis, we can get in there and do so much more.” The ointment comes in different concentrations, so therapists can choose the right one for each patient’s needs. E-motion offers cannabis cream as a $25 upgrade to any of its regular massage services, which run $100 to $120.
Similar results have been experienced across the country. “Collective Medical has been an integral part of our hospital system’s efforts to coordinate care for patients with complex needs,” says Dr. Maria Raven, MPH, MSc, a practicing emergency medicine physician and health services researcher and an associate professor of emergency medicine at UCSF. “With our partnership, we’re collaborating on our at-risk patients’ social determinants as well as curbing the opioid epidemic.”
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Les hôpitaux publics ne sont pas soumis à une convention collective, au contraire des établissements privés. En effet, la convention collective des établissements privés d’hospitalisation, de soins, de cure et de garde à but non lucratif doit être appliquée dans les établissements privés d’hospitalisation, de consultations et soins, de radiothérapie, de collecte de sang, etc. Les établissements privés de diagnostic, de services hospitaliers, d’hébergement médicalisé et social pour personnes âgées, sont concernés quant à eux par la convention collective de l’hospitalisation privée.

“We’ve been able to do a lot of querying ourselves, and we have some sepsis predictive models that we’ve created and put into place. We do a lot of real-time monitoring for sepsis and central line-associated bloodstream infections,” he says. “Central line-associated bloodstream infections are a bane for all hospitals. In the past year and a half, since we’ve put in our predictive model, we’ve had zero bloodstream infections, and that’s just unheard of.”
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“Proposition 64 would allow the state to impose a 15% excise tax on the retail sale of marijuana. Also, the state would be able to levy a cultivation tax on growers of $9.25 per ounce for flowers and $2.75 per ounce for leaves. The ballot measure also would let cities and counties to impose their own taxes to cover costs of services, including enforcement.” (Patrick McGreevy, Los Angeles Times)
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